COVID-19 and Stroke Trends in A Tertiary Care Center from South India -Our Monsoon Experience

Abstract

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.

Trends in stroke severity at hospital admission and rehabilitation discharge before and during the COVID-19 pandemic in Hesse, Germany: a register-based study

“…The results for the probable need for assistance due to major neurological deficits, as indicated by mRS > 2 points, show significantly lower rates at the beginning of COVID-19 wave 2 in August 2020 and at the beginning of COVID-19 wave 3 in March 2021. Some studies found no differences in NIHSS and mRS at admission [ 5 , 7 ], while others found differences [ 6 , 24 , 25 ], but in contrast to our results, patients had higher presenting NIHSS and mRS during the pandemic. However, the periods considered in these studies were short and involved small numbers of cases.…”

Prevalence and determinants of delays in care among premature deaths due to acute cardiac conditions and stroke in residents of a district in India

“…Hospital based studies have shown that during lockdown due to pandemic restrictions, there was an increase in delays in stroke and cardiac patients reaching the hospitals. 35 , 36 Our sub-analysis, though small in numbers, did not reveal higher health system access delay in deaths that occurred during the period when lockdown was imposed. The delays assessed qualitatively and quantitatively did not always arrive at same conclusion, for example, there might be no delays reported qualitatively yet they may reach AHF after 1 h. Though a formal sample size estimation was not done as a geographical defined area was saturated, the sample size appears to be sufficient to estimate proportion of delays, though not separately for stroke.…”