Background There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. Methods This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. Findings We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke—123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1–3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4–4.7, p = 0.006) were predictive of stroke. Interpretation The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients. Funding None.

Cerebral venous thrombosis (CVT) is rare and accounts for 0.5% of all strokes. Its clinical presentation is variable and diagnosis requires a high index of clinical suspicion in conjunction with neuroradiological diagnostic support. Treatment options are limited and are mostly based on consensus. Therefore, familiarity with international guidelines is important. Outcome is often good and most patients make a full recovery, although a small proportion suffers death or disability. Here, we describe the clinical features, risk factors, acute imaging features, management and complications of CVT.

Background and Purpose-Transcranial Doppler ultrasound can reliably detect both gaseous and solid cerebral emboli.However, conventional equipment is unable to discriminate between gaseous and solid emboli. This is a major limitation in situations in which the 2 coexist, because they may have very different clinical relevance. Recently, a novel Embo-Dop system, using insonation at 2 ultrasound transducer frequencies, has been developed. An initial study with a small sample size suggested it provided excellent discrimination. We performed a validation study in subjects with embolic signals of known nature. Methods-Gaseous embolic signals were obtained in 7 patients with known patient foramen ovale by intravenous injection of agitated saline injections. Solid embolic signals were obtained in patients with symptomatic carotid stenosis (Nϭ23). Discrimination of the 2 using the Embo-Dop system dual-frequency system was assessed. It was compared with discrimination using embolic signal maximum intensity with an intensity threshold. Results-One hundred forty-five solid embolic signals were recorded from carotid stenosis patients. Seventy-three were classified as solid and 72 as gaseous by the Embo-Dop system. Six hundred forty-eight gaseous embolic signals were recorded from 7 patients with patent foramen ovale. Six hundred twenty-five were classified as gaseous and 23 as solid. This gave a sensitivity of 50.3% and specificity of 96.5% for detecting solid embolic signals. Discrimination was better than using a simple intensity threshold. Key Words: cerebral circulation Ⅲ embolism Ⅲ ultrasonography, Doppler, transcranial E mbolism is the most common mechanism causing stroke and is also an important cause of neurological complications occurring during operations and interventional procedures. Transcranial Doppler ultrasound (TCD) can detect both gaseous and solid asymptomatic emboli. The detection of gaseous emboli was first described in the 1960s in decompression sickness 1 and during cardiopulmonary bypass surgery. 2 In the latter, the number of embolic signals (ES) has been correlated with cognitive outcome 3 and has been shown to be reduced by various operative procedures. 4 The detection of solid emboli was first described in the 1990s. 5 Presumed solid ES have been found in patients with a wide variety of potential embolic sources. Most work has been performed in symptomatic carotid arteries stenosis, in which the presence of ES predicts further stroke and transient ischemic attack risk. 6 -9 The technique is widely used for monitoring during carotid endarterectomy, and asymptomatic ES during both the dissection and postoperative phase have been shown to correlate with peri-operative stroke and transient ischemic attack risk. 10,11 A major problem, particularly when recording during operative interventions, is the failure of conventional TCD equipment to differentiate between solid and gaseous emboli. This is important because the neurological consequences of a few larger solid emboli are likely to be much greater ...