Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke.

BACKGROUND AND PURPOSE: We evaluated whether stroke severity, functional outcome, and mortality are different in patients with ischemic stroke with or without coronavirus disease 2019 (COVID-19) infection. METHODS: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had an acute ischemic stroke within 48 hours and a previous modified Rankin Scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, National Institutes of Health Stroke Scale score, rate of reperfusion therapies, logistics, and metrics. Primary end point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariable analyses. RESULTS: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men) and 91 (13%) had COVID-19 infection. Median baseline National Institutes of Health Stroke Scale score was higher in patients with COVID-19 compared with patients without COVID-19 (8 [3-18] versus 6 [2-14], P=0.049). Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariable logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among patients with COVID-19 and 16.1% in the non-COVID-19 group. In the multivariable logistic regression analysis, COVID-19 infection was a risk factor for mortality (hazard ratio, 3.14 [95% CI, 2.10-4.71]; P<0.001). CONCLUSIONS: Patients with ischemic stroke and COVID-19 infection have more severe strokes and a higher mortality than patients with stroke without COVID-19 infection. However, functional outcome is comparable in both groups.

Diffusion Restriction in the Optic Nerve and Retina in Patients With Carotid Occlusion.

OBJECTIVES: The primary role of magnetic resonance imaging (MRI) in a patient with suspected optic neuropathy is to rule out nonischemic disorders, and many of the reported cases of ischemic optic neuropathy with positive neuroimaging are atypical forms of ischemic optic neuropathy. We studied the role of diffusion-weighted images of MRI in patients with ocular ischemia. METHODS: We describe the clinical, fundoscopic and neuroimaging characteristics of 3 patients with definite ocular ischemia related to occlusion of the carotid artery. RESULTS: Diffusion-weighted images revealed typical changes of ischemia in a "cup of wine" shape, with increased signal intensity in diffusion-weighted imaging and a decrease in diffusivity in the apparent diffusion coefficient maps. A repeated MRI 8 days after presentation showed persistent hypointensity in apparent diffusion coefficient maps in 1 of the patients. CONCLUSIONS: Patients with ocular ischemia can disclose typical ischemic changes on dedicated brain MRI sequences. These findings might be beneficial in the diagnosis of patients with acute vision loss.