Recurrent/Subsequent Stroke and Associated Outcomes in Geriatric Patients with OSA and Prior Stroke Events: A Retrospective Study Using the 2019 National Inpatient Sample.

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS- groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78-2.64]; 3.18 [95% CI 2.58-3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08-1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08-1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14-2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.

Concurrent Cardio-Cerebral Infarctions in COVID-19: A Systematic Review of Published Case Reports/Series.

Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from three geographical locations, constituting the Middle East (7), Spain (3), and the USA (1). In 6 patients, IgG/IgM was positive for COVID-19, 4 with high pretest probability and 2 with positive RT-PCR. Type 2 DM, hyperlipidemia, and smoking were the primary risk factors. Right-sided neurological impairments and verbal impairment were the most common symptoms. Our analysis found 8 (66%) synchronous occurrences. In 58.3% of cases, neuroimaging showed left Middle Cerebral Artery (MCA) infarct and 33.3% right. Carotid artery thrombosis (16.6%), tandem occlusion (8.3%), and carotid stenosis (1%) were also reported in imaging. Dual antiplatelet therapy (DAPT) and anticoagulants were conservative therapies (10). Two AMI patients had aspiration thrombectomy, while three AIS patients had intravenous thrombolysis/tissue plasminogen activator (IVT-tPA), 2 had mechanical thrombectomy (MT), and 1 had decompressive craniotomy. Five had COVID-19-positive chest X-rays, whereas 4 were normal. four of 8 STEMI and 3 NSTEMI/UA patients complained chest pain. LV, ICA, and pulmonary embolism were further complications (2). Upon discharge, 7 patients (70%) had residual deficits while 1 patient unfortunately died.