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Title: Neurological complications of COVID-19 with particular reference to acute ischaemic stroke
Abstract:
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has a proven neurotropic potential and causes variety of neurological complications. Particularly important are cerebrovascular diseases, of which the most common is acute ischaemic stroke. This thesis is a series of three articles dedicated to selected aspects of neurological complications of SARS-CoV2 infection, with particular reference to acute ischaemic stroke. The aim of the first study was to assess the spectrum of neurological signs and symptoms presented in hospitalised patients with Coronavirus Disease 2019 (COVID-19) within the first 14 days of hospitalisation and to evaluate the association of their presence with in-hospital mortality. 200 adult patients, not requiring mechanical ventilation at admission, hospitalised in four departments of the University Hospital in Kraków between March and September 2020 were included into the study. Questionnaires concerning the presence of neurological signs and symptoms during hospitalisation were performed prospectively in 164 and retrospectively (based on detailed medical documentation) in 36 patients. Neurological signs and symptoms were found in most of the patients (84,5%). In 10% patients they were the first manifestation od COVID-19. The most common symptom was fatigue (62,5%). Patients who died during hospitalisation, compared to patients who survived, were ; significantly older (79 [70.5 – 88.5) vs 63.5 [51 – 77] years, p = 0.001), and more commonly presented decreased level of consciousness (50% vs 9.3%, p < 0.001), delirium (33.3% vs 4.4%, p < 0.001), arterial hypotension (50% vs 19.6%, p = 0.005), stroke during hospitalisation (18.8% vs 3.3%, p = 0.026) or had stroke in their medical history (50% vs 7.1%, p = 0.003). The patients who survived, compared to the patients who died, more commonly reported headache (42.1% vs 0%, p = 0.012) or lowered mood (51.7% vs 0%, p = 0.003). The aim of the second study was to assess if 4C Mortality Score (a scale created to predict mortality in hospitalised COVID-19 patients and so far only evaluated in patients with respiratory disease) can be used to predict outcome of patients with COVID-19-associated acute ischaemic stroke. 52 patients with acute ischaemic stroke associated with COVID-19 infection, hospitalised in seven neurological wards of the Małopolska Voivodship between August and December 2020 were included into the study. 4C Mortality Score at stroke onset was calculated retrospectively and data on in-hospital mortality, neurological deficit at discharge (measured using National Institute of Health Stroke Scale, NIHSS) and functional deficit at discharge (measured using modified Rankin scale, mRS) was gathered. There was a statistically significant moderate correlation between the 4C ; Mortality Score at stroke onset and functional outcome at discharge measured using mRS (rs = 0.565, p < 0.01). The patients who died in the hospital compared to those, who survived, had significantly higher 4C Mortality Score at stroke onset (13.08 +/- 2.71 vs 9.85 +/- 3.47, p = 0.04). The aim of the third study was to evaluate clinical profile and short-term outcome of patients with COVID-19 associated acute ischaemic stroke treated with mechanical thrombectomy (MT) in the Comprehensive Stroke Centre (CSC) of the University Hospital in Kraków and to compare them to patients with acute ischaemic stroke treated with MT in the same centre without concomitant SARS-CoV2 infection. The study included 15 patients with COVID-19-associated acute ischaemic stroke treated with MT and 167 patients with acute ischaemic stroke treated with MT without COVID-19. There were no statistically significant differences between the groups concerning sex, age, cardiovascular risk factors profile, stroke volume (as assessed with perfusion CT scanning), the percentage of patients treated with intravenous thrombolysis, the percentage of successful reperfusions (defined as Thrombolysis in cerebral infarction scale, TICI, 2b-3) nor short-term outcome (in-hospital mortality, neurological deficit at discharge measured with NIHSS, functional outcome at discharge measured with mRS). Patients with concomitant ; COVID-19 infection had significantly longer time from arrival to CSC to groin puncture (104.27 [SD=51.47] vs 97.63 [SD = 156.94] minutes, p = 0.044) as well as hospitalisation duration (23.7 [SD = 11.9] vs 10.5 [SD = 6.9] days, p < 0.001). To summarize, the results of studies included in this thesis suggest that neurological symptoms are present in the majority of hospitalised patients with COVID-19. Moreover, SARS-CoV-2 infection does not seem to worsen the outcome of patients with acute ischaemic stroke treated with mechanical thrombectomy. 4C Mortality Score may be useful for assessing short-term outcome of patients with COVID-19-associated acute ischaemic stroke.
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Rada Dyscypliny Nauki medyczne
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Słowik, Agnieszka ; Wnuk, Marcin
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Last modified:
Dec 5, 2024
In our library since:
Apr 26, 2024
Number of object content hits:
8
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0
All available object's versions:
http://dl.cm-uj.krakow.pl:8080/publication/5095
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| Edition name | Date |
|---|---|
| ZB-140218 | Dec 5, 2024 |
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