Background COVID-19 pandemic directly impacted the request for hospital care and medical assistance for several diseases worldwide, as occurred with acute ischemic stroke. The present study sought to compare the incidence and severity of acute ischemic stroke (AIS), in addition to sociodemographic, clinical, and radiological characteristics of patients hospitalized in the prepandemic (2018-2019) and pandemic (2020-2021) eras. Methods An incidence case-control, observational, and analytical research was carried out in the Stroke Unit of Hospital Governador Celso Ramos, Florianopolis, Santa Catarina, Brazil, including 171 patients admitted with acute ischemic stroke from April 2018 to April 2019 (prepandemic era) and 148 patients between January 2020 and January 2021 (during pandemic). ResultsThe mean incidence of AIS hospital admissions was significantly lower in the pandemic period (CI 95%, 0.2 to 5.6; p = 0.04), being lower in the lockdown periods and when the incidence of new COVID-19 cases increased. Besides, referring to AIS severity, the mean areas of AIS were larger during the pandemic period (p < 0.01), especially in August, September, December, and January (p < 0.05). Sociodemographic and clinical variables did not show any difference between the two periods of the study. Conclusions Hospital admissions for AIS decreased in the COVID-19 pandemic, mostly during months of higher incidences of new COVID-19 cases. When the incidence of admissions diminished, an increase in the severity of AIS was observed, characterized by larger areas. These findings might contribute to other similar referral centers in managing public policies related to stroke.

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Case Report A 58-year-old man, previously healthy, presented with headache, myalgia, retrosternal chest pain associated with paresthesia and paresis in upper limbs and lower limbs of acute onset. He denies fever, cough, dyspnea, or contact with patients with COVID-19. There was a difference in blood pressure and pulse in the upper limbs. No particularities in the neurological examination were noted. The electrocardiogram and enzymes of myocardial necrosis did not show abnormalities. PCR for SARS-CoV-2 was positive. Chest computed angiotomography showed acute type IA aortic dissection. The patient underwent cardiac surgery, without complications. After 48 hours of the procedure, the patient progresses with a lower level of consciousness, left hemiplegia, and anisocoria. The brain computed tomography showed extensive ischemic injury in the right middle cerebral artery territory. The patient underwent decompression craniectomy. The patient was discharged from the hospital, maintaining hemiplegia on the left side of the body. Discussion SARS-CoV-2 is a RNA virus responsible for the current COVID-191 pandemic. Moderate to severe forms of the disease may present with acute respiratory distress syndrome (ARDS), myocarditis, and thrombotic events such as pulmonary venous thromboembolism and ischemic stroke2. There are few reports in the literature about acute aortic dissection in patients with COVID-193,4. Acute aortic dissection is characterized by rupture of the intimal layer of the vessel with exposure of the middle layer and cystic necrosis and formation of a false lumen5. The mechanisms associated with thromboembolic phenomena in SARSCoV-2 infection remain poorly elucidated in the literature. This case report highlights a patient with severe complications of COVID-19, with the viral trigger being a possible contributor to the condition of acute aortic dissection and stroke.

Case presentation: A 4-year-old boy was born to non-consanguineous parents at 38 weeks. Neonatal anthropometric measurements were normal. Since birth, he presented with global developmental delay, and muscular hypotonia. At present, he shows adequate psychosocial interaction. He has a healthy 3-year-old sister. On physical examination, there are dysmorphisms, such as prominent and pointed ears, long eyelashes, elongated face, flat occipital region, supernumerary teeth, and maxillary hypoplasia. His anthropometric measurements are normal for his age (p50). On neurological examination, he presents with apraxia of speech, axial and appendicular hypotonia, and reduced deep tendon reflexes. Brain magnetic resonance imaging showed a slight thinning of the corpus callosum and mild ectasia of the lateral ventricles. Transthoracic echocardiography and ultrasound of the kidneys and urinary tract were normal. On genetic investigation, no abnormalities were found in karyotype and CGH-Array. Whole exome sequencing showed a pathogenic variant in the PUF60 gene (c.24+1G>C) in heterozygosis. Thus, the patient was diagnosed with Verheij syndrome. The patient is accompanied by physiotherapy, speech therapy, occupational therapy, and a psychopedagogy group. Discussion: Verheij syndrome is a rare condition caused by variants in the PUF60 gene, which encodes a component of the spliceosome. This syndrome is characterized by intellectual disability, delayed growth and neuropsychomotor development, facial dysmorphic features, and osteoarticular abnormalities. Also, there may be heart and kidney disorders. The spectrum of this disease’s manifestations and severity still need to be further explored in future studies, as well as the treatment and prognosis of this condition. Multidisciplinary support is essential for managing the consequences of the disease. This case report reinforces the leveraged importance that genetics has had in the diagnosis of intellectual disabilities.

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