Ramachandran Dileep, George Githin Benoy, Panicker Praveen, Aravind R, Suresh M K, Iype Thomas
Departments of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India.
Department of Infectious Disease, Government Medical College, Thiruvananthapuram, Kerala, India.
Neurol India. 2022 Sep-Oct;70(5):1942-1946. doi: 10.4103/0028-3886.359188.
The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases.
A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality.
Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months.
Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients.
新冠疫情期间前所未有的挑战以及随后的封锁导致急性中风的治疗指标出现延迟。人们越来越担心新冠病毒合并感染会对中风预后产生不利影响。我们旨在研究新冠病毒对中风患者管理的影响。我们还比较了新冠确诊病例中急性中风患者的中风表现、病因模式、治疗过程和预后的差异。
在特里凡得琅政府医学院的中风单元进行了一项单中心回顾性研究。纳入2020年5月至7月以及2019年5月至7月期间症状发作后24小时内通过影像学确诊的急性中风连续患者。主要数据变量包括基线人口统计学、危险因素、入院时美国国立卫生研究院卒中量表（NIHSS）评分、中风发生时间、溶栓率、TOAST病因分型、出院时改良Rankin量表（mRS）评分以及院内死亡率。
疫情期间，NIHSS评分、入院血糖和血压较高以及从入院到CT检查和从入院到溶栓的时间延迟的中风患者更多。疫情期间，新冠病毒感染导致的中风患者静脉溶栓治疗较少且死亡率较高。新冠病毒检测呈阳性的中风患者出血性中风更多、CT血管造影侧支循环评分（CT ASPECTS）较低的严重中风更多、出血性转化更多、院内死亡率高、出院时和3个月时功能预后较差。
我们的研究是一项样本量有限的假设生成性研究。这项研究再次证实了中风的严重程度更高，在疫情期间mRS评分和死亡率更高，尤其是在新冠病毒检测呈阳性的中风患者中。
