Connecting in COVID 19: Neurology tele-follow-up experience

IntroductionThe lockdown due to COVID-19 pandemic led to temporary closure of routine hospital services. This prompted the initiation of teleconsult follow-up in our department. The study outlines the experience of tele-follow-up at a tertiary care teaching hospital in India, and the perspective of neurologists about this novel approach. MethodsThe tele-follow-up was started from 26th March 2020. Data of follow up appointments was provided by the medical record section. The faculty and senior residents conducted the tele-follow-up. Communication was made via voice calls. The data for initial ten days was analyzed to find the utility and experience of the new service. ResultsIn the initial ten working days, data of 968 patients was provided for tele-follow-up. A successful communication was made in 50.3% patients (contact with patients: 27.7% and family members 22.6%). The phone numbers which were not contactable/invalid/not available constituted 36.8% of the data. A total of 35 faculty and residents conducted the tele-follow-up. The utility of tele-follow-up was perceived as good by 71.4% of neurologists. Majority of neurologists (71.4%) observed that >90% of patients were continuing medications. Patients outside the city constituted 50-75% of the list. The survey revealed that all neurologists felt the need to continue tele-follow-up for far off stable patients post lock down and resumption of regular outpatient services. ConclusionThe survey established the feasibility and utility of teleconsult for follow up of patients with neurological diseases who were attending the regular outpatient services before the lock down.

Stroke in Coronavirus Disease 2019: A Systematic Review / 대한뇌졸중학회지

Background@#and Purpose Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19. @*Methods@#Three authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables. @*Results@#We identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase. @*Conclusions@#The association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.

Risk Factors and Etiologies of Ischemic Strokes in Young Patients: A Tertiary Hospital Study in North India / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Stroke in young adults has a special significance in developing countries, as it affects the most economically productive group of the society. We identified the risk factors and etiologies of young patients who suffered ischemic strokes and were admitted to a tertiary referral hospital in North India. METHODS: A retrospective review of case records from patients with ischemic stroke in the age range of 18-45 years was conducted from 2005 to 2010. Data regarding patients' clinical profiles, medical histories, diagnostic test results, and modified Rankin Scale scores at hospital discharge were examined. Stroke subtyping was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. RESULTS: Of the 2,634 patients admitted for ischemic stroke, 440 (16.7%) were in the 18-45 year age range and the majority (83.4%) were male. The most common risk factors were hypertension (34.4%) and dyslipidemia (26.5%). The most common subtype of stroke was undetermined (57%), followed by other determined causes (17.3%). Among the category of undetermined etiology, incomplete evaluation was the most common. Most of the patients demonstrated good functional outcomes. CONCLUSIONS: Young adults account for 16.7% of all stroke patients in North India. Risk factors are relatively prevalent, and a high proportion of the patients are categorized under undetermined and other determined causes. The results highlight the needs for aggressive management of traditional risk factors and extensive patient work-ups to identify stroke etiology in India.

Prediction of stroke outcome in relation to Alberta Stroke Program Early CT Score (ASPECTS) atadmission in acute ischemic stroke: A prospective study from tertiary care hospital in north India

Objective: To evaluate correlation of Alberta Stroke Program Early CT Score (ASPECTS) and early and delay outcome measures among acute anterior ischemic stroke patients who presented within 48 hours of stroke onset. Methods: In a prospective cohort study, we recruited consecutive patients with acute middle cerebral artery (MCA) ischemic stroke who presented within 48 hours of stroke onset. All the patients were evaluated at admission (Glasgow Coma Scale - GCS and National Institute of Health Stroke Scale - NIHSS) at discharge (GCS, NIHSS, Barthel Index - BI and modifi ed Rankin Scale - mRS) and at 3 months (BI and mRS). CT ASPECTS was calculated by two observers independently. We divided patients in to two groups with ‘Better’ and ‘Worse’ ASPECTS with score of 8-10 and 0-7 respectively and compared the primary and secondary stroke outcome measures. Results: Among 100 patients with acute MCA infarction (median age 55 yrs, 62 males), median ASPECTS scores had inter-rater reliability of 0.82. The mortality, GCS and NIHSS at discharge, and mRS and BI at 3 months are signifi cantly better among patients with ‘Better’ compared to ‘Worse’ APSECTS. The hospital stay was shorter in patients with Better ASPCTS. Conclusion: In the setting of acute ischemic stroke, ASPECTS has good correlation with severity of stroke, and is strong predictor of early and delayed outcome in acute ischemic stroke.