Background As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. Aims The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. Methods The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. Results A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. Conclusions Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.

Background and Purpose: Occurrence of stroke has been reported among patients with COVID-19. The present study compares clinical features and outcomes of stroke patients with and without COVID-19. Methods: The COVID-19 Stroke Study Group (CSSG) is a multicentric study in 18 sites across India to observe and compare the clinical characteristics of patients with stroke admitted during the current pandemic period and a similar epoch in 2019. The present study reports patients of stroke with and without COVID-19 (CoVS and non-CoVS, respectively) seen between February 2020 and July 2020. Demographic, clinical, treatment, and outcome details of patients were collected. Results: The mean age and gender were comparable between the two groups. CoVS patients had higher stroke severity and extent of cerebral involvement on imaging. In-hospital complications and death were higher among CoVS patients (53.06% vs. 17.51%; P < 0.001) and (42.31% vs. 7.6%; P < 0.001), respectively. At 3 months, higher mortality was observed among CoVS patients (67.65% vs. 13.43%; P < 0.001) and good outcome (modified Rankin score [mRS]: 0–2) was seen more often in non-CoVS patients (68.86% vs. 33.33%; P < 0.001). The presence of COVID-19 and baseline stroke severity were independent predictors of mortality. Conclusions: CoVS is associated with higher severity, poor outcome, and increased mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and baseline stroke severity are independent predictors of mortality.

Introduction: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.Methodology: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.Results: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.Conclusion: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.

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Introduction: Chest Computed Tomography (CT) scan for Coronavirus Disease-2019 pneumonia is used widely and viral load is predicted by the Cycle threshold (Ct) values of Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Studies correlating viral load in Severe Acute Respiratory Syndrome- Coronavirus-2 (SARS-CoV-2) RT-PCR positive patients and severity of chest CT scan are limited. Aim: To find an association between viral load and chest CT findings. Materials and Methods: This was a cross-sectional study conducted on patients admitted to Believers Church Medical College Hospital, Thiruvalla, Kerala between September 2020 to March 2021. TrueNat RT-PCR test was performed on nasopharyngeal swabs, targeting the Orf1 gene of SARS-CoV-2 and results were quantified as Cycle threshold (Ct) values. Chest CT-Total Severity Score (TSS) ranged from 0-40 and was calculated by summing up the acute inflammatory lesions in each of the five lobes of both the lungs. Correlation was assessed using Spearman’s Correlation Coefficient. Independent sample t-test and one-way Analysis of Variance (ANOVA) were used for comparison of means. Results: Of the 102 patients in the study [mean age of the patients 64.13±13.17 years and majority were males (70.6%)], 11 had lung changes unrelated to COVID-19. There was an inverse relationship between viral load Ct value of SARS-CoV-2 in nasopharyngeal specimens and TSS of chest CT scan. The mean viral load was highest in patients with mild (21.48±8.31), moderate (21.22±6.30) and severe (24.19±4.67) CT involvement. There was a significant difference between mean duration to symptom onset and chest CT scan among those with a high viral load (4.97±2.65) compared to those with a low viral load (6.81±4.5), (p-value=0.01). Among those who died due to COVID- 19, (12/13) 92.3% were above 60 years of age. Presence of co- morbidities/dyspnoea/fever at presentation did not have any significant association with TSS severity. Conclusion: Viral load is not a critical factor that influences pulmonary manifestations in COVID-19, nor in-hospital mortality. CT scan may be more useful to detect lung involvement when done nearing or after the first week of symptom onset, irrespective of the viral load. Viral load can be important in predicting transmissibility and to minimise potential spread, whereas chest CT can help identify cases requiring extensive medical care.