Background and Purpose: Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known. Methods: We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results. Results: Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P <0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal ( P =0.02), parietal ( P =0.002), occipital ( P =0.002), and cerebellar ( P =0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay ( P <0.0001), greater percentage requiring intensive care unit care ( P =0.017), and greater rate of neurological worsening during admission ( P <0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P <0.0001). Conclusions: Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.

Purpose of Review This review presents an overview of the known neurocritical care complications of severe acute respiratory virus 2 (SARS-CoV-2). We present readers with a review of the literature of severe neurologic complications of SARS-CoV-2 and cases from our institution to illustrate these conditions. Recent Findings Neurologic manifestations are being increasingly recognized in the literature. Some patients can have severe neurologic manifestations, though the true prevalence is unknown. Summary Severe neurologic complications of COVID-19 include large vessel occlusion ischemic stroke, intracranial hemorrhage, encephalitis, myelitis, Guillain-Barre syndrome, status epilepticus, posterior reversible encephalopathy syndrome, and hypoxic-ischemic encephalopathy. These conditions can manifest in COVID-19 patients even in the absence of risk factors and must be promptly identified as they can have a high mortality if left untreated.

Elevated levels of mitochondrial nitrosative stress have been associated with the pathogenesis of both Parkinson's and Alzheimer's diseases. The mechanism involves catalytic poisoning of the endoplasmic reticulum (ER)-resident oxidoreductase chaperone, protein disulfide isomerase (PDI), and the subsequent accumulation of ER-processed substrate proteins. Using a model system to mimic mitochondrial oxidative and nitrosative stress, we demonstrate a PDI-independent mechanism whereby reactive oxygen species (ROS) compromise regeneration rates of disulfide bond-containing ER-processed proteins. Under ROS-duress, the secretion-destined traffic adopts disulfide-exposed structures making the protein flux retrotranslocation biased. We also demonstrate that ROS-compromised protein maturation rates can be rescued by the polyphenol ellagic acid (EA). Our results are significant in that they reveal an additional mechanism which could promote neurodegenerative disorders. Furthermore, our data reveal that EA possesses therapeutic potential as a lead prophylactic agent against oxidative/nitrosative stress-related neurodegenerative diseases.

Introduction: Parkinson's disease (PD) is a progressive neurodegenerative disease more common in those over the age of 60. PD is classically characterized by motor features, although patients may also experience non-motor symptoms. Sleep disturbances, such as rapid eye movement (REM) behavior disorder (RBD), are common in patients with PD and may precede onset of PD. Methods: Data was collected on patients with PD (358 subjects)in a movement disorders clinic at a safety net hospital. In this retrospective database analysis, the association of PD complications with age of onset was evaluated using chi-square tests and logistic regression. Results: Of the PD complications analyzed, there was a significant difference in sleep disturbances by age. Among the 358 PD patients, 120 individuals (33.5%) had information regarding the presence or absence of sleep disturbances. There was a significant difference between the early (onset < 50) and later onset (≥50) groups (p = 0.03) with the odds of having a sleep disorder for the early group 1.6 times that of the late group. Those subjects with siblings who also had PD had 2.0 times the odds of having a sleep disorder compared those without (p = 0.02). Conclusion: Non-motor symptoms such as sleep disorders are a useful predictor of early onset PD. Genetic components of PD impact both motor and non-motor aspects of the disease.

Background: Compulsive behavior, dyskinesias, motor fluctuations, and hallucinations are common Parkinson's disease (PD) medication side effects.These are yet to be examined in relation to race and level of education. The goal of this analysis was to identify socioeconomic or clinical variables that are associated with compulsive behavior, dyskinesias, motor fluctuations, and hallucinations in patients in a safety-net hospital. Methods: A movement disorder patient database containing 452 patients with idiopathic PD was analyzed for differences in PD medication side effects using univariate and multivariate logistic regression analysis. Race, sex, and level of education were evaluated as possible confounders. Results: A greater proportion of the patients in this study were Caucasian males. The only variable associated with compulsive behavior was age, with higher age having a protective effect (p = 0.0336). Disease duration (defined as time since the onset of symptoms), diagnosis duration (time since formal diagnosis), and level of education were significantly associated with dyskinesia inunivariate analysis (p =< 0.0001, <0.0001, 0.1236 respectively). However, diagnosis duration was the only variable significantly associated with dyskinesia in multivariate analysis (p = 0.0038), in addition to a borderline significant association when comparing individuals with graduate degree to those who had completed high school education or less (p = 0.0599), with a protective effect of higher education. Disease duration, diagnosis duration, and use of monoamineoxidase inhibitors were also significantly associated with motor fluctuations in the univariate analysis, while only diagnosis duration was significantly associated with motor fluctuations in multivariate analysis (p = 0.0035) with longer diagnosis duration associated with higher risk of motor fluctuations. Age, disease duration, and diagnosis duration were associated with an increased risk of hallucinations