Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4–18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4–18] versus 6 [IQR, 3–14]), P =0.03; (odds ratio, 1.69 [95% CI, 1.08–2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2–6] versus 2 [IQR, 1–4], P <0.001) and death (odds ratio, 4.3 [95% CI, 2.22–8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

No abstract

HighlightsIntracranial malignant peripheral nerve sheath tumors are an extremely rare pathology with a high morbidity and mortality.The most frequently affected cranial nerves in decreasing order of frequency are the trigeminal, vestibulocochlear and facial, being glossopharyngeal, vagus and spinal nerves extremely rare affected.This manuscript is the first in English-written literature to expose the case of an adult female patient with NF1 who presented a MPNST involving the glossopharyngeal, vagus and spinal left nerves with intracranial-extracranial extension and systemic metastases.Treatment strategies for this particular pathology are still unclear due to the low frequency of the disease and a lack of number of cases, making them a challenge for the neurosurgeon.

Background: Although the efficacy of intravenous thrombolysis (IV-T) has been widely demonstrated, the rates of its use continue to be low. Purpose: The purpose of this study was to assess the frequency of IV-T in Mexican hospitals and to describe the target times for acute treatment and the functional evolution of patients. Methods: Data prospectively collected from patients with acute ischemic stroke treated over a period of 2 years in four Mexican hospitals were analyzed. We assessed demographic data, the onset-to-door (OTD) time, the door-to-needle (DTN) time, treatment and the National Institutes of Health Stroke Scale (NIHSS), and modified Rankin scale (mRs) scores at the baseline and at the end of the follow-up. Results: There were 500 patients (mean age 57 ± 14 years, 274 [55%] men). The median OTD time was 11 h (range 30 min-190 h); the mean of NIHSS score was 10 ± 6. Eighty-seven (17.4%) patients arrived at the hospital within 4.5 h; but only 38 (7.6%) patients were treated with IV-T (mean of NIHSS 12 ± 6 points; with a mean OTD time of 2.1 h and a DTN time of 82 ± 51 min). After a median follow-up of 6 months (range 5-24 months), the final NIHSS score was 7 ± 6 points. A better prognosis was observed (mRs < 2) in patients who received IV-T (p = 0.04). Conclusions: The frequency of IV-T in Mexican hospitals continues to be <10%. A high percentage of patients continues to arrive at the hospital outside the therapeutic window.

No abstract