Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Neurol India. 2022 Mar-Apr;70(2):623-632. doi: 10.4103/0028-3886.344655.
An increased incidence of systemic macrothrombotic phenomena such as strokes has been observed in moderate and severe COVID. However, strokes have also been increasingly observed in mild COVID, post COVID, or without obvious COVID illness.
To share our experience with a specific stroke type noted during the COVID pandemic period.
A single-center observational study was conducted in Western India from January to December 2020, and data regarding stroke patients admitted under Neurology services were noted. Clinical, laboratory, and radiological characteristics of strokes and subtypes were documented.
A total of 238 stroke patients were admitted in 2020, 76.5% during the COVID pandemic period. Among 153 ischemic strokes, 16.3% and 56.2% had large vessel occlusion (LVO) in pre-COVID and COVID pandemic period, respectively. Of all ischemic strokes, 20.9% (18 patients) and 12% (3 patients) had free floating thrombus (FFT) in the COVID versus pre-COVID period, respectively. Only 44.4% of all FFT patients could be proven SARS-CoV-2 RT-PCR positive while 50% were COVID suspect with surrogate markers of heightened inflammation at time of stroke. All patients were given anticoagulation and average mRS at discharge was 3.1 (range: 1-6) and 1.84 (range: 0-4) at 3-month follow-up in survivors.
This study highlights the presence of FFT causing LVO as a new stroke subtype during the COVID-19 pandemic. With renewed and steeper spike in COVID-19 cases, especially new variants, the resurgence of this stroke subtype needs to be actively explored early in the course of illness to reduce morbidity and mortality.
在中重度 COVID 中观察到全身性巨栓现象（如中风）的发病率增加。然而，在轻度 COVID、新冠后或无明显 COVID 疾病中，中风的发病率也在逐渐增加。
分享我们在 COVID 大流行期间观察到的一种特定中风类型的经验。
2020 年 1 月至 12 月在印度西部进行了一项单中心观察性研究，记录了在神经科服务下住院的中风患者的数据。记录了中风和亚型的临床、实验室和影像学特征。
2020 年共收治 238 例中风患者，76.5%发生在 COVID 大流行期间。在 153 例缺血性中风中，分别有 16.3%和 56.2%在 COVID 前和 COVID 大流行期间发生大血管闭塞（LVO）。在所有缺血性中风中，分别有 20.9%（18 例）和 12%（3 例）在 COVID 期间和 COVID 前期间存在游离血栓（FFT）。只有 44.4%的所有 FFT 患者的 SARS-CoV-2 RT-PCR 呈阳性，而 50%的患者在中风时具有升高的炎症替代标志物，被怀疑为 COVID。所有患者均接受抗凝治疗，存活患者出院时平均 mRS 为 3.1（范围：1-6），3 个月随访时为 1.84（范围：0-4）。
本研究强调了在 COVID-19 大流行期间存在由 FFT 引起的 LVO 的新中风亚型。随着 COVID-19 病例的再次增加，尤其是新变种的出现，这种中风亚型的复发需要在疾病早期积极探索，以降低发病率和死亡率。
