Effect of COVID-19 pandemic on stroke admissions and quality of stroke interventional treatment in Masovian Voivodeship.

AIM OF STUDY: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the pathway of stroke interventional services and major quality indicators of stroke reperfusion therapies in Masovian Voivodeship. MATERIALS AND METHODS: An exploratory retrospective analysis was performed at two comprehensive stroke centres to assess changes in stroke care between the early phase of the COVID-19 pandemic (weeks 10-18 of 2020) and the same period in 2019. RESULTS: Of the 419 included stroke patients, 186 (44.4%) presented during the COVID-19 period. There was an increase in in-hospital delays for reperfusion therapies, and a significant decrease in the number of acute cerebrovascular accident admissions, predominantly related to a low number of transient ischaemic attack (TIA) admissions to hospital (-20.17%). The delays were shorter in the mothership paradigm than in the drip-and-ship paradigm of acute stroke care (onset-to-groin 293 vs. 232 min, p = 0.03). No differences in stroke aetiology, large-vessel occlusion frequency, or severe stroke admissions in the COVID-19 period were observed. CONCLUSIONS AND CLINICAL IMPLICATIONS: COVID-19's emergence was correlated with a significant reduction in admissions to stroke departments, particularly for TIAs, and a prolonged delay in reperfusion stroke treatment, especially in the drip-and-ship paradigm. An educational campaign to raise public awareness of TIA and/or stroke symptoms and immediate reorganisation of stroke care during the COVID-19 era are necessary.

Successful treatment with intravenous recombinant tissue plasminogen activator in an acute stroke patient presenting with hemiballism.

A 79-year-old woman with hypertension was evaluated 3 hours and 20 minutes after the sudden onset of left-sided weakness which lasted about 15 minutes and was followed by involuntary, coarse, flinging movements of the left extremities (hemiballistic), occurring every few minutes, and facial asymmetry. Brain computed tomography revealed no abnormalities. The patient received intravenous thrombolysis with 0.9 mg/kg of alteplase 4 hours after the symptom onset. Involuntary movements and central facial nerve paresis subsided within 48 hours of the thrombolysis. Magnetic resonance imaging at day 5 revealed restricted diffusion within the right globus pallidus, which was a new ischemic lesion. Thrombolysis should be considered in hemiballism as a presenting symptom of acute stroke.

Association between BDNF-196 G>A and BDNF-270 C>T polymorphisms, BDNF concentration, and rTMS-supported long-term rehabilitation outcome after ischemic stroke.

BACKGROUND: The efficacy of rehabilitation in ischemic stroke patients likely varies because of brain plasticity. One of the main neurotrophins in the central nervous system is brain-derived neurotrophic factor (BDNF). OBJECTIVES: This study aimed to determine allelic and genotypic distribution of BDNF-196 G>A and -270 C>T polymorphisms, and to assess the impact of repetitive transcranial magnetic stimulation (rTMS) on serum BDNF concentrations measured before rehabilitation, after the first 6 h of rehabilitation, and after 3 weeks of rehabilitation. METHODS: Twenty-six patients with hand paresis and 20 with aphasia were randomly assigned to treatment with rTMS or sham stimulation (placebo group). RESULTS: In men with aphasia, after the first 6 h of rTMS-supported rehabilitation, BDNF concentration was lower among rTMS-treated patients than placebo-treated patients. A similar difference was observed in women with aphasia after 3 weeks of rTMS-supported rehabilitation. No significant differences in serum BDNF concentration were observed in patients with different BDNF-196 G>A or -270 C>T genotypes. During the observation period, BDNF concentration did not differ significantly between patients who improved and those who did not. DISCUSSION: One possible explanation for the observed difference between rTMS-stimulated and sham-stimulated patients is the suppression of BDNF production by rTMS in the healthy brain hemisphere.

Transcranial magnetic stimulation combined with physiotherapy in rehabilitation of poststroke hemiparesis: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the contralesional primary motor cortex (M1) may improve recovery in patients with hemiparetic stroke. OBJECTIVE: To evaluate the effectiveness of applying 1 Hz rTMS to the contralesional M1 in addition to physiotherapy during early rehabilitation for stroke patients with hand hemiparesis in a randomized, sham-controlled, double-blind study. METHODS: Forty patients with moderate upper extremity hemiparesis were randomized to receive 3 weeks of motor training (45 minutes daily) preceded by 30 minutes of 1 Hz rTMS applied to the contralesional M1 or 30 minutes of sham rTMS. Functional assessment of the paretic hand using the Wolf Motor Function Test was performed before, immediately after, and 3 months after completing treatment. RESULTS: No statistically significant differences were found between the experimental and the control group for hand function (Wolf Motor Function Test; P = .92) or the level of neurological deficit (National Institutes of Health Stroke Scale [NIHSS]; P = .82) after treatment. Effect sizes for the experimental (d = 0.5) and the control group (d = 0.47) were small. Similar results were observed at the 3-month follow-up. CONCLUSIONS: The findings did not suggest that rTMS suppression of the contralesional motor cortex augments the effect of early neurorehabilitation for upper limb hemiparesis. Larger trials that stratify subjects based on residual motor function or physiological measures of excitation and inhibition may identify responders in the future.

[Transcranial magnetic stimulation in the therapy of selected post-stroke cognitive deficits: aphasia and visuospatial hemineglect]. / Przezczaszkowa stymulacja magnetyczna w terapii wybranych zaburzen poznawczych po udarze mózgu: afazji i zespole zaniedbywania wzrokowo-przestrzennego.

Over the last several years functional neuroimaging studies and neurophysiological investigations have provided greater insight into the mechanisms underlying neuroplasticity and recovery after stroke. Various techniques became available for the non-invasive modulation of human brain activity and allowed better rehabilitation programmes to be designed. One of these new techniques is transcranial magnetic stimulation (TMS). It is a painless brain stimulation technique that modulates cortical activity. Regularly repeated TMS delivered to a single scalp position (repetitive TMS, rTMS) has an effect on cortical excitability that lasts beyond the duration of the rTMS applications. The effects of rTMS on cortical excitability may be inhibitory or facilitatory depending on stimulation parameters. A growing number of studies consider rTMS as a potential therapeutic technique in neurological disorders. This method can be used as a complementary treatment to conventional therapy based on training of disturbed functions. In this review, we cite studies indicating that sessions of rTMS could improve some of the cognitive symptoms after stroke.

Acute respiratory distress syndrome as a manifestation of brain stem tumour--a case report.

Acute lung injury (ALI), including acute respiratory distress syndrome (ARDS), is a critical condition consisting of acute hypoxaemic respiratory failure with bilateral pulmonary infiltrates of non-cardiogenic origin. Occasionally it develops in patients with acute or subacute central nervous system pathologies, such as increased intracranial pressure and brain stem lesions. The exact epidemiology of neurogenic pulmonary oedema is unknown. However, due to non-specific clinical manifestation it often remains undiagnosed. Its pathogenesis probably involves overactivation of the sympathetic autonomic system with pulmonary hypertension and increased vessel permeability. We present a case of successfully managed ARDS in a previously healthy patient with newly diagnosed and symptomatic haemangioblastoma of the medulla oblongata. In this context we also review current knowledge on the aetiopathogenesis, diagnostic criteria and treatment for neurogenic ARDS.