To report neurological manifestations seen in patients hospitalized with Coronavirus disease 2019 (COVID-19) from a large academic medical center in Chicago, Illinois. Methods: We retrospectively reviewed data records of 50 patients with COVID-19 who were evaluated by the neurology services from March 1, 2020-April 30, 2020. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the "Neuro first" group had neurological manifestations upon initial assessment, and the "COVID first" group developed neurological symptoms greater than 24 h after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms and diagnoses of both groups were analyzed. Statistical analysis was performed to compare the two groups. Results: A total of 50 patients (48% African American and 24% Latino) were included in the analysis. Most common neurological manifestations observed were encephalopathy (n = 30), cerebrovascular disease (n = 20), cognitive impairment (n = 13), seizures (n = 13), hypoxic brain injury (n = 7), dysgeusia (n = 5), and extraocular movement abnormalities (n = 5). The "COVID-19 first" group had more evidence of physiologic disturbances on arrival with a more severe/critical disease course (83.3% vs 53.8%, p 0.025). Conclusion: Neurologic manifestations of COVID-19 are highly variable and can occur prior to the diagnosis of or as a complication of the viral infection. Despite similar baseline comorbidities and demographics, the COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses. Differently from previous studies, we noted a high percentage of African American and Latino individuals in both groups.

Following improvements in cancer survival rates quality of life (QOL) has become a key health outcome among cancer survivors. Neighborhood disadvantage has been shown to have a detrimental effect on health outcomes. To date, little is known regarding the influence of neighborhood disadvantage on the health-related QOL of cancer survivors. This study aimed to examine the associations between neighborhood disadvantage and health-related QOL among African American and White cancer survivors. Data were obtained from a retrospective survey study of African American (n=248) and White (n=244) cancer survivors. Physical (PHQOL) and mental health (MHQOL) QOL was measured by the Rand 36-Item Short Form. The neighborhood disadvantage index was created based four components, including prevalence of poverty, mother-only households, home ownership and the prevalence of college educated individuals living in the area. Covariates included demographic characteristics and clinical factors. To adjust the nesting effects of participants living in neighborhoods, a mixed effect linear regression model was conducted to test the association between neighborhood disadvantage and PHQOL and MHQOL after controlling for covariates. Regression results showed that patients living in more disadvantaged neighborhoods reported lower PHQOL than those in more advantaged places (β =−1.21, P=0.020). However, this relationship was not observed for MHQOL outcomes (β =−0.06, P=0.49). Race did not exert an independent influence on observed relationships. Study results contribute to a growing body of research documenting the detrimental effects of neighborhood disadvantage on cancer related outcomes.

Introduction: Various recreational drugs have been linked to cerebrovascular events, especially in young adults, however, few studies have examined relationships between substance abuse (SA) and acute ischemic stroke (AIS) in detail. The objective of this study was to determine prevalence and stroke mechanism in a cohort of AIS patients with SA and the impact of SA on outcomes and recovery. Methods: A retrospective case-control study comparing adults hospitalized with AIS with positive urine drug screen (UDS, excluding cannabis and its related products) from January 2015 to December 2019 compared with matched AIS controls from Greater Chicago area. Logistic regression was used to compare demographics, mechanism of stroke, discharge outcomes as measured by modified Rankin Scale (mRS), and disposition outcomes. Results: Out of 3229 AIS patients, 141 (6.5%) has positive UDS (SA group) and were compared to 282 controls. Illicit drugs used were cocaine (69%), opiates (21%), and the rest were amphetamines, phencyclidine, ecstasy, or multiple substances. Demographically, there were no significant differences in age [56.0±10.0 years vs 55.9±10.5], or sex [men 63.1% vs 60.3%]. Controls had higher rates of traditional stroke risk factors [diabetes (DM), p=0.0001 and hyperlipidemia (HLD), p=0.004], and a higher incidence of large artery atherosclerosis as suspected stroke mechanism than the SU group (p = 0.001). SA group at discharge had higher levels of disability [median mRS 2 vs 3 (p = 0.001)] and worse discharge disposition, i.e. subacute rehab/long term care facility/hospice/death vs home or acute rehabilitation (OR 0.49, p =0.009, CI 0.29-0.84), even after correcting for age, sex, HTN, DM, coronary artery disease, and HLD in a multiple logistic regression (OR 0.43, p= 0.004, CI 0.24-0.76). Conclusion: In our cohort, patients with AIS and SA were more likely to have a stroke mechanism of large artery atherosclerosis and poorer outcomes with higher levels of disability and worse discharge disposition.

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Objectives: Non traumatic intracerebral hemorrhage (ICH) is responsible for 10-20% of acute stroke events and carries significant mortality concern. The protocol at our comprehensive stroke centers (CSC) is to admit all ICH patients to Neurosciences Intensive Care Unit (NSICU). We also have a stroke Intermediate Care Unit (IMCU) at our hospital which is a dedicated stroke unit where patients can be closely monitored and maintained on IV nicardipine. Optimal bed utilization is essential at our busy referral center. We aimed to develop criteria to identify ICH patients at low risk for clinical deterioration who could be admitted directly to our IMCU rather than the NSICU thereby improving overall utilization of monitored beds. Methods: Retrospective chart review for patients admitted between July 2018-Dec 2018 was performed. Age, sex, race, presenting Glasgow coma scale (GCS), ICH score, ICH volume, presence of IVH and location of the hemorrhage was documented. Patients who did not need any neurosurgical procedures (external ventricular drain, craniectomy or hematoma evacuation) and were not documented to have acute respiratory failure during their admission were considered appropriate for IMCU admission and were further assessed for hematoma expansion to determine stability throughout their hospital course. Results: 118 patients with ICH were included in the analysis, out of which 61 patients were suitable for IMCU admission. On univariable analysis, patients that had lower ICH scores (0.6±0.7 vs 2.5±0.9) and higher GCS score (14.1±1.4 vs 7.8±3.7) did not need any acute intervention. In this group of patients, only 9 (14.7%) patients had hematoma expansion documented out of which 6 (67%) patients had coagulation abnormalities on admission either due to medications or low platelet count. Conclusions: We conclude that the patients who had admission ICH score < 2, GCS ≥ 12 and no coagulation abnormalities on admission could have safely been admitted to our IMCU instead of the NSICU for further care and management. This would have led to a decrease in ICU admission rate. Application of such separate protocols for stroke IMCU admission vs ICU admission would lead to better utilization of resources at comprehensive stroke centers throughout the country.