Impact of the COVID-19 outbreak on acute stroke pathways - insights from the Alsace region in France.

BACKGROUND AND PURPOSE: To date, no study has attempted to quantify the impact of the COVID-19 outbreak on the incidence and treatment of acute stroke. METHODS: This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1-31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume. RESULTS: Compared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (-0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%), P = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions. CONCLUSION: These results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID-19 outbreak on acute stroke care.

[An atypical form of neurosarcoidosis]. / Neurosarcoïdose de présentation atypique.

INTRODUCTION: Nervous system involvement occurs in 5 to 15% of the patients with sarcoidosis. Neurosarcoidosis remains very difficult to diagnose because clinical presentation and imaging characteristics lack specificity. OBSERVATION: We report a 26-year-old man who gradually developed headaches, memory disturbance and epilepsy. CT-scan and MRI showed a temporal-parietal cystic mass, secondary to a rare and focal form of hydrocephalus, called "trapped temporal horn" revealing neurosarcoidosis. CONCLUSION: The "entrapped temporal horn" is due to an obstacle on the cerebrospinal fluid pathway at the trigone of the lateral ventricle that seals off the temporal horn and the choroid plexus from the rest of the ventricular system. The obstacle is related to the granulomatous tissue of sarcoidosis. Therefore, the "trapped temporal horn" acts as a space occupying process, causing headaches, memory pain, hemiparesis, homonymous hemianopsia, and requires medico-surgical management.