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1.
Artigo em Alemão | MEDLINE | ID: mdl-33053590

RESUMO

The removal of a central venous catheter on a ward leads to a paradox air embolism in a 53-year-old male patient with an unknown ventricular septal defect. The patient undergoes sufficient cardiopulmonary resuscitation but suffers from a multiple stroke syndrome with serious neurological deficits.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Embolia Aérea , Acidente Vascular Cerebral , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Infarto Cerebral , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia
2.
Rev Prat ; 70(6): 610-613, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058599

RESUMO

When to think early about a stroke and what to do ? Rapid recognition of stroke symptoms leads to early treatment and improved clinical outcomes, with direct impact on stroke survival and functional outcome. The typical clinical presentation of a stroke consists of a sudden onset of a focal neurological deficit of maximum intensity at onset. Typical warning symptoms, that have been promoted in public awareness campaigns, are the sudden unilateral numbness or weakness of face, arm, or leg, especially on one side of the body, speech difficulty and visual trouble. It may also happen that a stroke has an unusual clinical presentation, 'false negatives' are called 'stroke chameleons', because the clinical presentation suggests another disorder. The call of the emergency number (number 15 in France) is the first thing to do in case of stroke symptom recognition. Stroke code allows to stroke management anticipation and significantly reduces the delays for early treatment.


Assuntos
Conscientização , Acidente Vascular Cerebral , França , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
3.
Rev Prat ; 70(6): 617-620, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058601

RESUMO

Prehospital management of acute stroke patients. In France, prehospital management of patients with suspected acute stroke relies on emergency medical communication centers (Samu), which provides first-line telephone assessment and dispatches the most appropriate emergency vehicle. Such tasks are not straightforward because many clinical symptoms may correspond to stroke and alternative diagnoses - stroke mimics - are common. It is crucial to reduce both prehospital and hospital delays in patients eligible for reperfusion therapies, namely intravenous thrombolysis and/or mechanical thrombectomy. Because mechanical thrombectomy only applies to patients with acute ischemic stroke and large-vessel occlusion, prehospital triage is important. However, clinical prediction of large-vessel occlusion is difficult and whether a specific patient should be sent to the nearest primary stroke center (drip and ship paradigm) or a comprehensive stroke center with thrombectomy capability (mothership paradigm) remains uncertain. Prehospital notification of the hospital-based stroke teams by the emergency medical system crews is crucial in reducing delays to achieve reperfusion.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , França/epidemiologia , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Trombectomia , Triagem
4.
J Korean Med Sci ; 35(35): e324, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32893524

RESUMO

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic infection associated with high morbidity and mortality. The Korean city of Daegu endured the first large COVID-19 outbreak outside of China. Since the report of the first confirmed case in Daegu on February 18, 2020, a total of 6,880 patients have been reported until May 29, 2020. We experienced five patients with ischemic stroke and COVID-19 during this period in four tertiary hospitals in Daegu. The D-dimer levels were high in all three patients in whom D-dimer blood testing was performed. Multiple embolic infarctions were observed in three patients and suspected in one. The mean time from stroke symptom onset to emergency room arrival was 22 hours. As a result, acute treatment for ischemic stroke was delayed. The present case series report raises the possibility that the coronavirus responsible for COVID-19 causes or worsens stroke, perhaps by inducing inflammation. The control of COVID-19 is very important; however, early and proper management of stroke should not be neglected during the epidemic.


Assuntos
Infecções por Coronavirus/patologia , Citocinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Pneumonia Viral/patologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , República da Coreia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Tromboembolia/patologia , Terapia Trombolítica/métodos , Tempo para o Tratamento
6.
Hu Li Za Zhi ; 67(5): 44-55, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978765

RESUMO

BACKGROUND: Studies have shown that oral health is closely related to systemic diseases. Poor oral hygiene may lead to dental caries and periodontal disease and also increase the risk of cardiovascular disease. Patients with stroke have a possibility of recurrence, and good oral health is expected to benefit their general health. Nevertheless, nursing research exploring the oral health and oral hygiene behaviors of stroke patients has been rare. PURPOSE: To explore the factors significantly associated with oral health status and oral hygiene behaviors in patients with stroke. METHODS: A cross-sectional research design with convenient sampling was used. Information on health promoting behaviors and oral health status was collected in a teaching hospital in southern Taiwan. A multivariate linear regression model was applied to explore the factors associated with oral health status in patients with stroke. RESULTS: One hundred and eight-five patients with stroke were enrolled in this study. The average number of real teeth was 11.3 and the average score for oral health status was 4. The univariate analysis showed that being 65 years of age or older, having an education level below primary school, having a lower Barthel index score, having a higher modified Rankin scale score, not brushing and flossing, not having a regular tooth cleaning, having a lower of health promotion score, and having insufficient water intake levels were all associated with a worse oral health status. The stepwise regression analysis showed that factors affecting oral health status include health promotion behaviors, age, tooth brushing, and water intake, which, together, accounted for 28.5% of the total variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings indicate that oral health status, oral hygiene behaviors, and health promoting behaviors are inadequate among patients with stroke. Clinicians should promote health-related behaviors early to their patients with stroke, specifically in terms of implementing proper oral hygiene behaviors in daily routine care.


Assuntos
Saúde Bucal/estatística & dados numéricos , Higiene Bucal/psicologia , Acidente Vascular Cerebral/terapia , Idoso , Estudos Transversais , Hospitais de Ensino , Humanos , Fatores de Risco , Taiwan
7.
J Stroke Cerebrovasc Dis ; 29(10): 105077, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912524

RESUMO

BACKGROUND: As Covid-19 evolved into a world-wide pandemic, hospitals reported marked declines in strokes, only to be followed by reports of increased numbers of young people presenting with large-vessel occlusions. We reviewed our patient data-base to determine if similar or other novel trends were present. RESULTS: Our Thrombectomy Stroke Center experienced marked declines in ED visits from 2,349 in early March to 1,178 in late April, stroke alerts dropped from 34 to 14 during the same period. Average monthly stroke admissions dropped from 34 in 2019 to 23 in 2020. Nonetheless, in March, we had 12 patients eligible for tPA, which is twice the typical caseload and was unexpected given the low overall stroke presentations. Although the neurointervention caseload was low, the patients were significantly younger. Of the acute intervention patients in March, 5 of the 12 patients were ≤ 60 years old, and two were in their 30's. These trends are similar to those reported elsewhere but were highly unusual for our center as our catchment area is predominantly Caucasian with 34 % of the population > 65 years of age. CONCLUSIONS: Even in low risk centers Covid-19 will likely impart unique stroke presentations. It will be imperative to determine the mechanisms responsible for these changes so we can institute effective strategies for optimal stroke prevention as well as maintain timely acute interventions.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Florida/epidemiologia , Interações entre Hospedeiro e Microrganismos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/virologia , Trombectomia , Terapia Trombolítica , Fatores de Tempo
8.
J Stroke Cerebrovasc Dis ; 29(10): 105114, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912527

RESUMO

BACKGROUND: Little is known about the effect of the Coronavirus disease 2019 pandemic on stroke care and the impact of the epidemic on acute stroke hospitalizations has not been described. METHODS: We analyze the stroke admission rate in three hospitals in New York City from January 1, 2020 through April 17, 2020, identifying all cases of acute ischemic stroke, intraparenchymal hemorrhage and subarachnoid hemorrhage. RESULTS: We confirmed 518 cases of out-of-hospital stroke. During the baseline period up to February 25, 2020, the daily stroke admission rate was stable, with the slope of the regression describing the number of admissions over time equal to -0.33 (se = 1.21), not significantly different from 0 (p = 0.79), with daily admissions averaging 41. During the pandemic period, the slope was -4.4 (se = 1.00); i.e., the number of stroke admissions decreased an average of 4.4 per week, (p = 0.005), with weekly admissions averaging 23, a reduction of 44% versus baseline. This general result was not different by patient age, sex, or race/ethnicity. CONCLUSIONS: The weekly stroke admission rate started declining two weeks prior to the local surge of coronavirus admissions. The consequences of lack of diagnosis and treatment of a large proportion of acute stroke patients are likely severe and lasting.


Assuntos
Infecções por Coronavirus/terapia , Assistência à Saúde/tendências , Hemorragias Intracranianas/terapia , Admissão do Paciente/tendências , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Idoso , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Interações entre Hospedeiro e Microrganismos , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/virologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/virologia , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/terapia , Fatores de Tempo
9.
J Stroke Cerebrovasc Dis ; 29(10): 105179, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912564

RESUMO

BACKGROUND: Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. METHODS: A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. RESULTS: Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110-4.132). CONCLUSION: Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/tendências , Pneumonia Viral/terapia , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/terapia , Betacoronavirus/patogenicidade , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Definição da Elegibilidade/tendências , Pesquisas sobre Serviços de Saúde , Interações Hospedeiro-Patógeno , Humanos , Exposição Ocupacional/prevenção & controle , Pandemias , Admissão do Paciente/tendências , Transferência de Pacientes/tendências , Equipamento de Proteção Individual/tendências , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Formulação de Políticas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/virologia , Telemedicina/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
10.
Arq Neuropsiquiatr ; 78(7): 440-449, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32756857

RESUMO

INTRODUCTION: Although the 2019 severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2, COVID-19) pandemic poses new challenges to the healthcare system to provide support for thousands of patients, there is special concern about common medical emergencies, such as stroke, that will continue to occur and will require adequate treatment. The allocation of both material and human resources to fight the pandemic cannot overshadow the care for acute stroke, a time-sensitive emergency that with an inefficient treatment will further increase mortality and long-term disability. OBJECTIVE: This paper summarizes the recommendations from the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Society of Cerebrovascular Diseases and the Brazilian Society of Neuroradiology for management of acute stroke and urgent neuro-interventional procedures during the COVID-19 pandemic, including proper use of screening tools, personal protective equipment (for patients and health professionals), and patient allocation.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Gerenciamento Clínico , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Neurologia/normas , Pneumonia Viral/prevenção & controle , Acidente Vascular Cerebral/terapia , Betacoronavirus , Brasil , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Sociedades Médicas
11.
Orv Hetil ; 161(34): 1395-1399, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32804669

RESUMO

INTRODUCTION: Early international observations report decreased number of acute ischemic stroke admissions and prolonged onset-to-treatment times during COVID-19 pandemic. AIM: Our goal was to assess the effect of COVID-19 pandemic on Hungarian acute ischemic stroke care. METHOD: We compared demographical and clinical characteristics, rate of intravenous and endovascular therapies and therapeutic time parameters of acute ischemic strokes admitted to a university stroke centre in a COVID-epidemic period (01/03/2020-30/04/2020) and an identical period of 2019. RESULTS: 86 patients were admitted during the COVID-period and 97 in the control period. Demographical and clinical characteristics of these periods were well-balanced. In the COVID-period, the proportion of patients arriving beyond 24 hours after onset increased by 13% (p = 0.046), the rate of endovascular interventions remained unchanged (8%), the rate of intravenous thrombolysis decreased from 26% to 16%, the mean onset-to-treatment time of thrombolysis increased by 20 minutes, while the mean door-to-treatment time increased by only 5 minutes. Behind the shift of arrival time categories, multivariable (year of examination, NIHSS, age) logistic regression shows that the year of examination might play a leading role (p = 0.096). CONCLUSION: In the COVID-period, admissions for acute ischemic strokes decreased by 11% and the proportion of cases certainly untreatable by reperfusion therapies (arriving beyond 24 hours after onset) increased significantly. While the rate of endovascular interventions remained unchanged, the absolute rate of intravenous thrombolysis decreased by 10% and the mean onset-to-treatment time showed a tendency to increase. In these changes, the COVID-epidemic itself and related out-of-hospital factors might play a leading role. Orv Hetil. 2020; 161(34): 1395-1399.


Assuntos
Isquemia Encefálica/terapia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/terapia , Humanos , Hungria/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos
12.
Mayo Clin Proc ; 95(8): 1704-1708, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32753143

RESUMO

On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic, and in the weeks following, public health organizations, medical associations, and governing bodies throughout the world recommended limiting contact with others to "flatten the curve" of COVID-19. Although both ischemic and hemorrhagic strokes have been reported with COVID-19, there has been anecdotal suggestion of an overall decrease in stroke admissions. To date, the effects of any pandemic on telestroke service lines have not been described. The purpose of this cross-sectional analysis of telestroke activations in the 30 days before and after the declaration of the COVID-19 pandemic is to describe the difference in case volumes of telestroke activations, the characteristics of patients, and treatment recommendations between the 2 time frames. We found a 50.0% reduction in total telestroke activations between the predeclaration group (142 patients) and the postdeclaration group (71 patients). There were no statistically significant differences in age (P=.95), sex (P=.10), diagnosis (P=.26), or regional variations (P=.08) in activation volumes. The percentage of patients for whom we recommended urgent stroke treatment with intravenous alteplase, mechanical thrombectomy, or both decreased from 44.4% (28 of 63) to 33.3% (11 of 33). The reasons for the sunstantial decrease in telestroke activations and urgent stroke treatment recommendations are likely multifactorial but nevertheless underscore the importance of continued public health measures to encourage patients and families to seek emergency medical care at the time of symptom onset.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Utilização de Instalações e Serviços/tendências , Pandemias , Pneumonia Viral , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Telemedicina/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
13.
Medicine (Baltimore) ; 99(30): e21366, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791743

RESUMO

The utility of endovascular thrombectomy for acute occlusion of the distal intracranial artery (A2/A3/M2/M3/P2/P3) is unclear, and aspiration and stent thrombectomy are associated with risk of bleeding. We analyzed patients with acute occlusion of the distal intracranial artery to assess the safety and efficacy of microcatheter-based tirofiban infusion.We retrospectively reviewed data of the endovascular thrombectomy registry of our center between January 2018 and June 2019. Patients with distal intracranial artery occlusion who underwent endovascular thrombectomy with microcatheter-based infusion of tirofiban were recruited.Of 13 patients included, 1 presented with anterior cerebral artery occlusion, 2 with posterior cerebral artery occlusion, 2 with posterior inferior cerebellar artery occlusion, and 7 with middle cerebral artery M2 occlusion. The mean National Institute of Health Stroke scale score was 10.1 (3-19). Three patients (23.1%) underwent bridging treatment of intravenous thrombolysis with recombinant plasminogen activator and endovascular thrombectomy. The arithmetic mean onset-to-recanalization time was 696.3 minutes (140-1440) and average operating time was 47.1 minutes (30-80). After treatment, 10 patients (76.9%) underwent revascularization. No operative complications were observed in any case. All patients underwent angiography and were reviewed 7 to 14 days after surgery. Imaging revealed significant improvements in recanalization compared with the immediate postoperative period, with no reoccurrence of occlusion. The mean modified Rankin scale score at the 3-month follow-up was 0.54 (0-2).Microcatheter-based infusion of bolus-dose tirofiban can result in safe and effective recanalization of acute occlusion of the distal artery in the case of a relatively light thrombotic load.


Assuntos
Fibrinolíticos/administração & dosagem , Doenças Arteriais Intracranianas/terapia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/métodos , Tirofibana/administração & dosagem , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Doenças Arteriais Intracranianas/complicações , Doenças Arteriais Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
14.
Medicine (Baltimore) ; 99(34): e21783, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846808

RESUMO

BACKGROUND: Scalp acupuncture is remarkable in improving neurological dysfunction of ischemic stroke patients. This study aims to systematically evaluate the efficacy and safety of scalp acupuncture in improving neurological dysfunction of ischemic stroke patients. METHODS: Randomized controlled trials of scalp acupuncture against ischemic stroke patients will be searched in PubMed, Web of Science, Embase, Cochrane Library, the Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database, China National Knowledge Infrastructure, and Wanfang database from inception to July, 2020. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS: This study will summarize the present evidence by exploring the efficacy and safety of scalp acupuncture in improving neurological dysfunction in ischemic stroke patients. CONCLUSIONS: The findings of the study will help to determine potential benefits of scalp acupuncture against ischemic stroke at different stage. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/T26P8.


Assuntos
Terapia por Acupuntura/métodos , Doenças do Sistema Nervoso/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Terapia por Acupuntura/efeitos adversos , Isquemia Encefálica/complicações , Humanos , Metanálise como Assunto , Doenças do Sistema Nervoso/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Couro Cabeludo , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto
15.
Stroke ; 51(9): 2664-2673, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755347

RESUMO

BACKGROUND: Anecdotal reports suggest fewer patients with stroke symptoms are presenting to hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We quantify trends in stroke code calls and treatments at 3 Connecticut hospitals during the local emergence of COVID-19 and examine patient characteristics and stroke process measures at a Comprehensive Stroke Center (CSC) before and during the pandemic. METHODS: Stroke code activity was analyzed from January 1 to April 28, 2020, and corresponding dates in 2019. Piecewise linear regression and spline models identified when stroke codes in 2020 began to decline and when they fell below 2019 levels. Patient-level data were analyzed in February versus March and April 2020 at the CSC to identify differences in patient characteristics during the pandemic. RESULTS: A total of 822 stroke codes were activated at 3 hospitals from January 1 to April 28, 2020. The number of stroke codes/wk decreased by 12.8/wk from February 18 to March 16 (P=0.0360) with nadir of 39.6% of expected stroke codes called from March 10 to 16 (30% decrease in total stroke codes during the pandemic weeks in 2020 versus 2019). There was no commensurate increase in within-network telestroke utilization. Compared with before the pandemic (n=167), pandemic-epoch stroke code patients at the CSC (n=211) were more likely to have histories of hypertension, dyslipidemia, coronary artery disease, and substance abuse; no or public health insurance; lower median household income; and to live in the CSC city (P<0.05). There was no difference in age, sex, race/ethnicity, stroke severity, time to presentation, door-to-needle/door-to-reperfusion times, or discharge modified Rankin Scale. CONCLUSIONS: Hospital presentation for stroke-like symptoms decreased during the COVID-19 pandemic, without differences in stroke severity or early outcomes. Individuals living outside of the CSC city were less likely to present for stroke codes at the CSC during the pandemic. Public health initiatives to increase awareness of presenting for non-COVID-19 medical emergencies such as stroke during the pandemic are critical.


Assuntos
Isquemia Encefálica/epidemiologia , Hemorragias Intracranianas/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Estudos de Coortes , Comorbidade , Connecticut/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Infecções por Coronavirus/epidemiologia , Dislipidemias/epidemiologia , Serviços Médicos de Emergência , Grupos Étnicos , Feminino , Humanos , Hipertensão/epidemiologia , Renda , Seguro Saúde , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/fisiopatologia , Hemorragias Intracranianas/terapia , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Telemedicina , Trombectomia , Terapia Trombolítica
16.
Stroke ; 51(9): 2674-2682, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755348

RESUMO

BACKGROUND AND PURPOSE: No studies have reported the effect of the coronavirus disease 2019 (COVID-19) epidemic on patients with preexisting stroke. We aim to study the clinical course of COVID-19 patients with preexisting stroke and to investigate death-related risk factors. METHODS: We consecutively included 651 adult inpatients with COVID-19 from the Central Hospital of Wuhan between January 2 and February 15, 2020. Data on the demography, comorbidities, clinical manifestations, laboratory findings, treatments, complications, and outcomes (ie, discharged or death) of the participants were extracted from electronic medical records and compared between patients with and without preexisting stroke. The association between risk factors and mortality was estimated using a Cox proportional hazards regression model for stroke patients infected with severe acute respiratory syndrome coronavirus 2. RESULTS: Of the 651 patients with COVID-19, 49 with preexisting stroke tended to be elderly, male, had more underlying comorbidities and greater severity of illness, prolonged length of hospital stay, and greater hospitalization expenses than those without preexisting stroke. Cox regression analysis indicated that the patients with stroke had a higher risk of developing critical pneumonia (adjusted hazard ratio, 2.01 [95% CI, 1.27-3.16]) and subsequent mortality (adjusted hazard ratio, 1.73 [95% CI, 1.00-2.98]) than the patients without stroke. Among the 49 stroke patients, older age and higher score of Glasgow Coma Scale or Sequential Organ Failure Assessment were independent risk factors associated with in-hospital mortality. CONCLUSIONS: Preexisting stroke patients infected with severe acute respiratory syndrome coronavirus 2 were readily predisposed to death, providing an important message to individuals and health care workers that preventive measures must be implemented to protect and reduce transmission in stroke patients in this COVID-19 crisis.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Comorbidade , Infecções por Coronavirus/terapia , Progressão da Doença , Registros Eletrônicos de Saúde , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , Pandemias , Pneumonia/etiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
17.
Stroke ; 51(9): e227-e231, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32757751

RESUMO

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection. METHODS: Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior. RESULTS: Eighty-six COVID-19-positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P<0.001), mortality (29.1% versus 9.0%; P<0.001), and Black/multiracial race (58.1% versus 36.9%; P=0.001). COVID-19 was the strongest independent risk factor for in-hospital stroke (odds ratio, 20.9 [95% CI, 10.4-42.2]; P<0.001), whereas COVID-19, older age, and intracranial hemorrhage independently predicted mortality. CONCLUSIONS: COVID-19 is an independent risk factor for stroke in hospitalized patients and mortality, and stroke presentations are frequently atypical.


Assuntos
Transtornos Cerebrovasculares/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Angiografia Cerebral , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/terapia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Grupos Étnicos , Feminino , Mortalidade Hospitalar , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Neuroimagem , New York/epidemiologia , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
18.
Stroke ; 51(9): e254-e258, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32787707

RESUMO

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4-18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4-18] versus 6 [IQR, 3-14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08-2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2-6] versus 2 [IQR, 1-4], P<0.001) and death (odds ratio, 4.3 [95% CI, 2.22-8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.


Assuntos
Isquemia Encefálica/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Estudos de Coortes , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/terapia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Pontuação de Propensão , Recuperação de Função Fisiológica , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Análise de Sobrevida , Tempo para o Tratamento , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
PLoS One ; 15(8): e0237185, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760103

RESUMO

Several cohort studies have shown that periodontal disease is associated with an increased risk for stroke. However, it remains unclear whether serum antibody titers for a specific periodontal pathogen are associated with outcome after ischemic stroke, and which kinds of pathogens are associated with ischemic stroke. We examined the relationship between serum IgG titers to periodontal pathogens and outcome in ischemic stroke patients. A total of 445 patients with acute ischemic stroke (194 female [44.0%], mean age 71.9±12.3 years) were registered in this study. Serum IgG titers to 9 periodontal pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Prevotella nigrescens, Fusobacterium nucleatum, Treponema denticola, Tannerella forsythensis, Campylobacter rectus, Eikenella corrodens) were evaluated using the enzyme-linked immunosorbent assay (ELISA) method. An unfavorable outcome was defined as a 3 or higher on the modified Rankin Scale. The proportion of patients with unfavorable outcome was 25.4% (113 patients). Based on multivariate logistic regression analysis, numbers of IgG antibodies positive for periodontal pathogens (odds ratio 1.20, 95% CI 1.02-1.41, p = 0.03) were independent predictors of unfavorable outcome in ischemic stroke patients.


Assuntos
Periodontite Agressiva/epidemiologia , Anticorpos Antibacterianos/sangue , Isquemia Encefálica/epidemiologia , Imunoglobulina G/sangue , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Periodontite Agressiva/sangue , Isquemia Encefálica/microbiologia , Isquemia Encefálica/terapia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Sorológicos/estatística & dados numéricos , Acidente Vascular Cerebral/microbiologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
20.
J Stroke Cerebrovasc Dis ; 29(9): 104938, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807412

RESUMO

BACKGROUND AND PURPOSE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. METHODS: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. CONCLUSION: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Hospitalização/tendências , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Disparidades em Assistência à Saúde/tendências , Mortalidade Hospitalar/tendências , Interações Hospedeiro-Patógeno , Humanos , Incidência , Análise de Séries Temporais Interrompida , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
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