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Sebastian IA, de Souza AC, Gebrewold MA, Gandhi DBC, Cano-Nigenda V, Ferguson C, Gebreyohanns M, Lioutas VA. Fostering a Culture of Research: From Recommendations to Implementation. Stroke 2024. [PMID: 38690650 DOI: 10.1161/strokeaha.123.042385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Ivy Anne Sebastian
- Department of Neuroclinical Sciences, Foothills Medical Centre, University of Calgary (I.A.S.)
| | | | | | - Dorcas B C Gandhi
- College of Physiotherapy, CMC Ludhiana, Punjab, India. (D.B.C.G.)
- Department of Neurology, CMC Ludhiana, Punjab, India. (D.B.C.G.)
| | - Vanessa Cano-Nigenda
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico (V.C.-N.)
| | - Caleb Ferguson
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia (C.F.)
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, NSW, Australia (C.F.)
| | | | - Vasileios-Arsenios Lioutas
- Department of Neurology Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (V.-A.L.)
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Coutinho JM, van de Munckhof A, Aguiar de Sousa D, Poli S, Aaron S, Arauz A, Conforto AB, Krzywicka K, Hiltunen S, Lindgren E, Sánchez van Kammen M, Shu L, Bakchoul T, Belder R, van den Berg R, Boumans E, Cannegieter S, Cano-Nigenda V, Field TS, Fragata I, Heldner MR, Hernández-Pérez M, Klok FA, Leker RR, Lucas-Neto L, Molad J, Nguyen TN, Saaltink DJ, Saposnik G, Sharma P, Stam J, Thijs V, van der Vaart M, Werring DJ, Wong Ramos D, Yaghi S, Yeşilot N, Tatlisumak T, Putaala J, Jood K, Arnold M, Ferro JM. Reducing the global burden of cerebral venous thrombosis: An international research agenda. Int J Stroke 2024:17474930241242266. [PMID: 38494462 DOI: 10.1177/17474930241242266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Due to the rarity of cerebral venous thrombosis (CVT), performing high-quality scientific research in this field is challenging. Providing answers to unresolved research questions will improve prevention, diagnosis, and treatment, and ultimately translate to a better outcome of patients with CVT. We present an international research agenda, in which the most important research questions in the field of CVT are prioritized. AIMS This research agenda has three distinct goals: (1) to provide inspiration and focus to research on CVT for the coming years, (2) to reinforce international collaboration, and (3) to facilitate the acquisition of research funding. SUMMARY OF REVIEW This international research agenda is the result of a research summit organized by the International Cerebral Venous Thrombosis Consortium in Amsterdam, the Netherlands, in June 2023. The summit brought together 45 participants from 15 countries including clinical researchers from various disciplines, patients who previously suffered from CVT, and delegates from industry and non-profit funding organizations. The research agenda is categorized into six pre-specified themes: (1) epidemiology and clinical features, (2) life after CVT, (3) neuroimaging and diagnosis, (4) pathophysiology, (5) medical treatment, and (6) endovascular treatment. For each theme, we present two to four research questions, followed by a brief substantiation per question. The research questions were prioritized by the participants of the summit through consensus discussion. CONCLUSIONS This international research agenda provides an overview of the most burning research questions on CVT. Answering these questions will advance our understanding and management of CVT, which will ultimately lead to improved outcomes for CVT patients worldwide.
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Affiliation(s)
- Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- Stroke Center, Centro Hospitalar Universitário Lisboa Central, Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, and L Lopes Lab, Instituto de Medicina Molecular JLA, Lisbon, Portugal
| | - Sven Poli
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | - Adriana B Conforto
- LIM-44, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Sini Hiltunen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Liqi Shu
- Brown University, Providence, RI, USA
| | - Tamam Bakchoul
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Rosalie Belder
- Netherlands Thrombosis Foundation, Voorschoten, The Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Suzanne Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vanessa Cano-Nigenda
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Isabel Fragata
- Stroke Center, Centro Hospitalar Universitário Lisboa Central, Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, and L Lopes Lab, Instituto de Medicina Molecular JLA, Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Mirjam R Heldner
- Inselspital Bern, University Hospital and University of Bern, Bern, Switzerland
| | | | - Frederikus A Klok
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronen R Leker
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lia Lucas-Neto
- North Lisbon University Hospital Center and Lisbon Medical School, Lisbon, Portugal
| | | | | | | | - Gustavo Saposnik
- Stroke Outcomes & Decision Neuroscience Research Unit, University of Toronto, Toronto, ON, Canada
| | - Pankaj Sharma
- Royal Holloway University of London, London, United Kingdom
| | - Jan Stam
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | | | - David J Werring
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Diana Wong Ramos
- Portugal AVC-União de Sobreviventes, Familiares e Amigos, Portugal
| | | | - Nilüfer Yeşilot
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Marcel Arnold
- Inselspital Bern, University Hospital and University of Bern, Bern, Switzerland
| | - José M Ferro
- Hospital da Luz, University of Lisbon, Lisbon, Portugal
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Calva-González M, Tello-Gerez TJ, Serrano-Arias F, Cano-Nigenda V, Ramírez-Bermúdez J. The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia. J Psychiatr Pract 2023; 29:493-498. [PMID: 37948175 DOI: 10.1097/pra.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
We report a patient with cerebral venous thrombosis who initially presented with psychosis and who then progressed to delirium and catatonia within a few days. Upon treatment and resolution of the thrombosis, she presented complete remission of the psychiatric disturbances. This case highlights a specific neuropsychiatric presentation of cerebral venous thrombosis involving psychosis, catatonia, and delirium, which, to our best knowledge, has not been reported in the neurological or psychiatric literature. However, it reminds us of mental status and behavioral abnormalities which are not infrequent features of cerebral venous thrombosis. This leads to a discussion regarding the psychopathology, etiology, and pathophysiology of the case.
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Rosales J, Corredor-Quintero ÁB, Carbonera LA, Alet MJ, Amaya P, Cano-Nigenda V, Barboza MA, Navia V, Jiménez CA, Guerrero R, de Souza AC. Regional Initiatives to Empower Young Medical Doctors: The Young Stroke Latin American Task Force. Cerebrovasc Dis 2023; 53:233-238. [PMID: 37399805 DOI: 10.1159/000531649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Julieta Rosales
- Vascular Neurology Division, Department of Neurology, Fleni, Buenos Aires, Argentina
| | | | | | - Matías J Alet
- Vascular Neurology Division, Department of Neurology, Fleni, Buenos Aires, Argentina
| | - Pablo Amaya
- Department of Neurology, Stroke Program, Fundación Valle del Lili, Cali, Colombia
| | - Vanessa Cano-Nigenda
- Stroke clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica
| | - Victor Navia
- Department of Medicine Clínica, Cerebrovascular Program, Neurology Service, Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Claudio Alejandro Jiménez
- Head of Neurology and Director of the Stroke Center, Hospital Simón Bolívar, Subred Norte, Bogotá, Colombia
| | - Rodrigo Guerrero
- Neurology Department, Hospital de Santa Cruz, Clínica Santa María, Santiago, Chile
| | - Ana Cláudia de Souza
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
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Sposato LA, Martins S, Scheitz JF, Aspberg S, Gurol ME, Abdalla M, Arauz A, Cano-Nigenda V, Fiorilli P, Israel C, Kusano K, Mansour O, Messé SR, Pille A, Secchi T, Polanczyk CA, Biolo A, Ramadan I, Sallam A, Schäbitz W, Toyoda K, Valencia S, Wang S, Xiong Y, Zaki A, Saposnik G, Fisher M, Bahit MC. World Stroke Organization Brain & hEart globAl iniTiative Program. Cerebrovasc Dis 2023; 53:115-124. [PMID: 37276846 DOI: 10.1159/000530471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION The World Stroke Organization (WSO) Brain & Heart Task Force developed the Brain & hEart globAl iniTiative (BEAT), a pilot feasibility implementation program to establish clinical collaborations between cardiologists and stroke physicians who work at large healthcare facilities. METHODS The WSO BEAT pilot project focused on atrial fibrillation (AF) and patent foramen ovale (PFO) detection and management, and poststroke cardiovascular complications known as the stroke-heart syndrome. The program included 10 sites from 8 countries: Brazil, China, Egypt, Germany, Japan, Mexico, Romania, and the USA The primary composite feasibility outcome was the achievement of the following 3 implementation metrics (1) developing site-specific clinical pathways for the diagnosis and management of AF, PFO, and the stroke-heart syndrome; (2) establishing regular Neurocardiology rounds (e.g., monthly); and (3) incorporating a cardiologist to the stroke team. The secondary objectives were (1) to identify implementation challenges to guide a larger program and (2) to describe qualitative improvements. RESULTS The WSO BEAT pilot feasibility program achieved the prespecified primary composite outcome in 9 of 10 (90%) sites. The most common challenges were the limited access to specific medications (e.g., direct oral anticoagulants) and diagnostic (e.g., prolonged cardiac monitoring) or therapeutic (e.g., PFO closure devices) technologies. The most relevant qualitative improvement was the achievement of a more homogeneous diagnostic and therapeutic approach. CONCLUSION The WSO BEAT pilot program suggests that developing neurocardiology collaborations is feasible. The long-term sustainability of the WSO BEAT program and its impact on quality of stroke care and clinical outcomes needs to be tested in a larger and longer duration program.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Heart and Brain Laboratory, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Sheila Martins
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Jan F Scheitz
- Klinik für Neurologie mit Experimenteller Neurologie and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sara Aspberg
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed Abdalla
- Neurology Department, Armed Forces Medical Institute in Alexandria, Alexandria, Egypt
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Paul Fiorilli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carsten Israel
- Department of Cardiology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ossama Mansour
- Stroke and Neurointerventional Center, Alexandria University School of Medicine, Alexandria, Egypt
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania., Philadelphia, Pennsylvania, USA
| | - Arthur Pille
- Brazilian Stroke Network, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thaís Secchi
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | | | - Andreia Biolo
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ismail Ramadan
- Neurology Department, Alexandria University School of Medicine, Alexandria, Egypt
| | - Ashraf Sallam
- Cardiology and Angiology Department, Armed Forces Medical Institute, Alexandria, Egypt
| | - Wolf Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sharon Valencia
- Cardiology and Echocardiography Department, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suárez, Mexico City, Mexico
| | - Shang Wang
- Department of Neurocardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Xiong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Amr Zaki
- Cardiology Department, Alexandria University School of Medicine, Alexandria, Egypt
| | - Gustavo Saposnik
- Department of Medicine (Neurology), Stroke Outcomes & Decision Neuroscience Research Unit, University of Toronto, Toronto, Canada
| | - Marc Fisher
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Cecilia Bahit
- Department of Cardiology, INECO Neurociencias Rosario, Rosario, Argentina
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Marto JP, Strambo D, Ntaios G, Nguyen TN, Herzig R, Czlonkowska A, Demeestere J, Mansour OY, Salerno A, Wegener S, Baumgartner P, Cereda CW, Bianco G, Beyeler M, Arnold M, Carrera E, Machi P, Altersberger V, Bonati L, Gensicke H, Bolognese M, Peters N, Wetzel S, Magriço M, Ramos JN, Sargento-Freitas J, Machado R, Maia C, Machado E, Nunes AP, Ferreira P, Pinho e Melo T, Dias MC, Paula A, Correia MA, Castro P, Azevedo E, Albuquerque L, Alves JN, Ferreira-Pinto J, Meira T, Pereira L, Rodrigues M, Araujo AP, Rodrigues M, Rocha M, Pereira-Fonseca Â, Ribeiro L, Varela R, Malheiro S, Cappellari M, Zivelonghi C, Sajeva G, Zini A, Gentile M, Forlivesi S, Migliaccio L, Sessa M, La Gioia S, Pezzini A, Sangalli D, Zedde M, Pascarella R, Ferrarese C, Beretta S, Diamanti S, Schwarz G, Frisullo G, Marcheselli S, Seners P, Sabben C, Escalard S, Piotin M, Maïer B, Charbonnier G, Vuillier F, Legris L, Cuisenier P, Vodret FR, Marnat G, Liegey JS, Sibon I, Flottmann F, Broocks G, Gloyer NO, Bohmann FO, Schaefer JH, Nolte C, Audebert HJ, Siebert E, Sykora M, Lang W, Ferrari J, Mayer-Suess L, Knoflach M, Gizewski ER, Stolp J, Stolze LJ, Coutinho JM, Nederkoorn P, van den Wijngaard I, De Meris J, Lemmens R, De Raedt S, Vandervorst F, Rutgers MP, Guilmot A, Dusart A, Bellante F, Calleja-Castaño P, Ostos F, González-Ortega G, Martín-Jiménez P, García-Madrona S, Cruz-Culebras A, Vera R, Matute MC, Fuentes B, Alonso-de-Leciñana M, Rigual R, Díez-Tejedor E, Perez-Sanchez S, Montaner J, Díaz-Otero F, Pérez-de-la-Ossa N, Flores-Pina B, Muñoz-Narbona L, Chamorro A, Rodríguez-Vázquez A, Renú A, Ayo-Martin O, Hernández-Fernández F, Segura T, Tejada-Meza H, Sagarra-Mur D, Serrano-Ponz M, Hlaing T, See I, Simister R, Werring D, Kristoffersen ES, Nordanstig A, Jood K, Rentzos A, Šimůnek L, Krajíčková D, Krajina A, Mikulik R, Cviková M, Vinklárek J, Školoudík D, Roubec M, Hurtikova E, Hrubý R, Ostry S, Skoda O, Pernicka M, Jurak L, Eichlová Z, Jíra M, Kovar M, Panský M, Mencl P, Palouskova H, Tomek A, Janský P, Olšerová A, Sramek M, Havlicek R, Malý P, Trakal L, Fiksa J, Slovák M, Karlinski MA, Nowak M, Sienkiewicz-Jarosz H, Bochynska A, Wrona P, Homa T, Sawczynska K, Slowik A, Wlodarczyk E, Wiacek M, Tomaszewska-Lampart I, Sieczkowski B, Bartosik-Psujek H, Bilik M, Bandzarewicz A, Dorobek M, Zielinska-Turek J, Nowakowska-Kotas M, Obara K, Urbanowski P, Budrewicz S, Guziński M, Świtońska M, Rutkowska I, Sobieszak-Skura P, Labuz-Roszak BM, Debiec A, Staszewski J, Stępień A, Zwiernik J, Wasilewski G, Tiu C, Terecoasă EO, Radu RA, Negrila A, Dorobat B, Panea C, Tiu V, Petrescu S, Ozdemir A, Mahmoud M, El-Samahy H, Abdelkhalek H, Al-Hashel J, Ismail II, Salmeen A, Ghoreishi A, Sabetay SI, Gross H, Klein P, Abdalkader M, Jabbour P, El Naamani K, Tjoumakaris S, Abbas R, Mohamed GA, Chebl A, Min J, Hovingh M, Tsai JP, Khan M, Nalleballe K, Onteddu S, Masoud H, Michael M, Kaur N, Maali L, Abraham MG, Khandelwal P, Bach I, Ong M, Babici D, Khawaja AM, Hakemi M, Rajamani K, Cano-Nigenda V, Arauz A, Amaya P, Llanos N, Arango A, Vences MÁ, Barrientos Guerra JD, Caetano R, Martins RT, Scollo SD, Yalung PM, Nagendra S, Gaikwad A, Seo KD, Georgiopoulos G, Nogueira RG, Michel P. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry. Neurology 2023; 100:e739-e750. [PMID: 36351814 PMCID: PMC9969910 DOI: 10.1212/wnl.0000000000201537] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION The study was registered under ClinicalTrials.gov identifier NCT04895462.
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Affiliation(s)
- João Pedro Marto
- Department of Neurology (J.P.M., M.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Stroke Centre (D.S., A.S., P.M.), Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Switzerland; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology, Radiology (T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Department of Neurology (R.H., L.S., D.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; 2nd Department of Neurology (A.C., M.A.K., M.N.), Institute of Psychiatry and Neurology, Warsaw, Poland; Neurology Department (J.D., R.L.), Leuven University Hospital, Belgium; Alexandria University Hospitals and Affiliated Stroke Network (O.Y.M.), Egypt; Department of Neurology (S.W., P.B.), University Hospital of Zurich, Switzerland; Stroke Center (C.W.C., G.B.), Neurocenter of Southern Switzerland, EOC, Lugano; Stroke Center (M.B, M.A.), Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Stroke Centre (E.C.), Geneva University Hospital, Switzerland; Department of Neuroradiology (P.M.), Geneva University Hospital, Switzerland; Stroke Centre (V.A, L.B., H.G.), University Hospital Basel and University of Basel, Switzerland; Stroke Centre (M.B.), Kantonsspital Lucerne, Switzerland; Stroke Centre (N.P., S.W.), Hirslanden Hospital, Zurich, Switzerland; Department of Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Department of Neurology (J.S.-F., R.M., C.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Department of Neuroradiology (E.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Stroke Unit (A.P.N., P.F.), Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Stroke Unit (T.P.e.M., M.C.D., A.P.), Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neuroradiology (M.A.C.), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neurology (P.C., E.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Department of Neuroradiology (L.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Departments of Neurology (J.N.A., J.F.-P.), and Neuroradiology (T.M.), Hospital de Braga, Portugal; Department of Neurology (L.P., M.R.), Hospital Garcia de Orta, Almada, Portugal; Department of Neuroradiology (A.P.A., M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (A.P.-F, L.R.), Unidade Local de Saúde de Matosinhos, Portugal; Department of Neurology (R.V., S.M.), Centro Hospitalar Universitário do Porto, Portugal; Stroke Unit (M.C., C.Z.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z., M.G., S.F., L.M.), Department of Neurology and Stroke Centre, Maggiore Hospital, Bologna, Italy; Department of Neurology (M.S., S.L.G.), ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology and Stroke Unit (D.S.), Azienda Socio Sanitaria Territoriale, Lecco, Italy; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Department of Neurology (C.F., S.B., S.D.), San Gerardo Hospital, Department of Medicine and Surgery and Milan Centre for Neuroscience, University of Milano Bicocca, Monza, Italy; Stroke Unit (G.S.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neurology (G.F.), Policlinico Universitario Agostino Gemelli, Rome, Italy; Emergency Neurology and Stroke Unit (S.M.), IRCCS Humanitas Clinical and Research Center, Rozzano, Italy; Department of Neurology (C.S., S.E.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (M.P., B.M.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (G.C., F.V.), Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France; Neurology (F.L., P.C, F.R.V.), Stroke Unit, Centre Hospitalier Universitaire, Grenoble Alpes, France; Department of Interventional and Diagnostic Neuroradiology (J.-S.L., I.S.), Bordeaux University Hospital, France; Department of Diagnostic and Interventional Neuroradiology (F.F, G.B., N.-O.G.), University Medical Center-Hamburg-Eppendorf, Germany; Department of Neurology (F.O.B., J.H.S.), University Hospital Frankfurt, Goethe University, Germany; Department of Neurology and Centre for Stroke Research (H.J.A.), Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany; Department of Neuroradiology (E.S.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.S, W.L., J.F.), St. John's Hospital, Vienna, Austria; Departments of Neurology (L.M.-S., M.K.), and Neuroradiology (E.R.G.), Medical University of Innsbruck, Austria; Department of Neurology (J.S., L.J.S., J.M.C.), Amsterdam University Medical Centers, Netherlands; Department of Neurology (I.v.d.W., J.d.M.), Haaglanden Medical Centre, Hague and Department of Radiology, Leiden University Medical Centre, Netherlands; Department of Neurology (S.D.R., F.V.), Universitair Ziekenhuis Brussel, Centre for Neurosciences, Vrije Universiteit Brussel, Belgium; Department of Neurology (M.P.R, A.G.), Stroke Unit, Europe Hospitals, Brussels, Belgium; Department of Neurology (A.D., F.B.), Centre Hospitalier Universitaire de Charleroi, Belgium; Department of Neurology and Stroke Centre (P.C.-C., F.O., P.M.-J.), Hospital Universitario de OctubreInstituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Neurology and Stroke Centre (A.C.-C., R.V., M.C.M.), Hospital Universitario Ramón y Cajal, Ramon y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Department of Neurology and Stroke (B.F, M.A.d.L., R.R., E.D.D.), Centre Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain; Department of Neurology (S.P.-S., J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Stroke Centre (F.D-.O.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Stroke Unit (B.F.-P., J.M.-N.), Germans Trias Hospital, Barcelona, Spain; Department of Neurology (A.C, A.R.-V., A.R), Comprehensive Stroke Centre, Hospital Clinic from Barcelona, Spain; Department of Neurology (O.A.-M, F.H.-F.), Complejo Hospitalario Universitario de Albacete; Stroke Unit (H.T.-M.), Department of Neurology, and Interventional Neuroradiology Unit, Hospital Universitario Miguel Servet, Spain; Stroke Unit (D.S.-M, M.F.P.), Department of Neurology, Hospital Universitario Miguel Servet, Spain; Stroke and Geriatric Medicine (T.H.), Aintree University Hospital, United Kingdom; Comprehensive Stroke Service (I.S., R.S.), University College London Hospitals NHS Foundation Trust and Stroke Research Centre, University College London, United Kingdom.; University College London (D.W.), Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology (E.S.K.), Akershus University Hospital, Lørenskog and Department of General Practice, University of Oslo, Norway; Department of Clinical Neuroscience (A.N, K.J.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology (A.N, K.J.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.R.), Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; International Clinical Research Centre (R.M., M.C., J.V.) and Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine at Masaryk University, Brno, Czech Republic; Center for Health Research (D.S., M.R, E.H.), Faculty of Medicine, University of Ostrava, Czech Republic; Department of Neurology (R.H, S.V.), České Budějovice Hospital, Czech Republic; Department of Neurology (O.S., M.P.), Jihlava Hospital, Czech Republic; Neurocenter (L.J., Z.E., M.J.), Regional Hospital Liberec, Czech Republic; Cerebrovascular Centre (M.K., M.P., P.M.), Na Homolce Hospital, Prague, Czech Republic; Department of Neurology (H.P.), Karviná Miners Hospital Inc., Czech Republic; Cerebrovascular Centre (A.T, P.J, A.O.), University Hospital in Motol, Prague, Czech Republic; Cerebrovascular Centre (M.S., R.H, P.M., L.T.), Central Military Hospital, Prague, Czech Republic; Cerebrovascular Centre (J.F., M.S.), General University Hospital, Prague, Czech Republic; 1th Department of Neurology (H.S.-J, A.B.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (P.W, T.H., K.S., A.S), University Hospital, Jagiellonian University, Cracow, Poland; Department of Neurology (M.W., L.T.-L., B.S.), Institute of Medical Sciences, Medical College of Rzeszow University, Poland; Department of Neurology and Stroke (M.B, A.B.), St. John Paul II Western Hospital, Grodzisk Mazowiecki, Poland; Department of Neurology (M.D, J.Z.), Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland; Departments of Neurology (M.N.-K., K.O., P.U.), and Radiology (M.G.), Wroclaw Medical University, Poland; Department of Neurosurgery and Neurology (M.S.), Nicolaus Copernicus University in Torun Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Stroke Intervention Centre (I.R., P.S.-S.), Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Bydgoszcz, Poland; Department of Neurology (B.M.L.-R.), Institute of Medical Sciences, University of Opole, Poland; Clinic of Neurology (A.D., J.S., A.S.), Military Institute of Medicine, Warsaw, Poland; Department of Neurology (J.Z.), University of Warmia and Mazury, Olsztyn, Poland; Department of Radiology (C.W.), Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology (C.T., E.O.T., R.A.R., A.N.), University Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Romania; Department of Radiology (B.D.), University Emergency Hospital Bucharest, Romania; Department of Neurology and Stroke Unit (C.P, V.T, S.P.), Elias University Emergency Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Neurology (A.O.), Eskisehir Osmangazi University, Turkey; Ain Shams University Affiliated Saudi German Hospital (M.M., H.E.-S.), Egypt; Neuropsychiatry Department (H.A.), Tanta University, Egypt; Department of Neurology (J.A.-H.), Ibn Sina Hospital, Kuwait; Department of Neurology (I.I.I.), Jaber Al-Ahmad Hospital, Kuwait; Department of Neurology (A.G.), School of Medicine, Zanjan University of Medical Sciences, Iran; Stroke Unit (S.I.S.), Neurology Department, Hillel Yaffe Medical Center, Hadera, Israel; Department of Neurosurgery (P.J., K.E.N, S.T., R.A.), Thomas Jefferson University Hospital, PA; Departments of Radiology (G.A.M., P.G.N.), Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, GA; Department of Neurology (A.C.), Henry Ford Hospital, Detroit, MI; Comprehensive Stroke Centre and Department of Neurosciences (J.M., M.H., M.K.), Spectrum Health and Michigan State University; Department of Neurology (K.N., S.O.), University of Arkansas for Medical Sciences, Little Rock, AR; Department of Neurology (M.K.), Upstate University Hospital, NY; Department of Neurology (L.M., M.G.A.), University of Kansas Medical Centre; Endovascular Neurological Surgery and Neurology (P.K., I.B, M.O., M.B.), Rutgers, The State University of New Jersey, Newark; Department of Neurology (A.M.K.), Wayne State University, Detroit Medical Center, MI; Stroke Clinic (V.C.-N, A.A.), Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico; Department of Neurology (P.A.), Fundación Valle del Lili, Cali, Colombia; Centro de Investigaciones Clínicas (N.L., A.A.), Fundación Valle del Lili, Cali, Colombia; Department of Neurology (M.A.V.), Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Péru; Hospital General San Juan de Dios (J.D.B.G.), Guatemala; Department of Neurology (R.C., R.T.M.), Hospital Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil; Ramos Mejía Hospital (S.D.S.), Stroke Unit, Buenos Aires, Argentina; St. Luke's Medical Center (P.M.Y.), Global City, Philippines; Department of Neurology (S.N., A.G.), Grant Medical College and Sir JJ Hospital, Mumbai, India; Department of Neurology (K.-D.S.), National Health Insurance Service Ilsan Hospital, Goyang, Korea; School of Biomedical Engineering and Imaging Sciences (G.G.), St Thomas Hospital, King's College London, UK; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece.
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Orjuela KD, Barboza MA, Amaya PF, De Souza AC, Cano-Nigenda V, NAVIA GONZALEZ VICTORHUGO, Guerrero R, Alet M, Jimenez-Monsalve CA, Carbonera L, Corredor AB, rosales JS. Abstract HUP11: Alliance Of Young Neurologists To Examine And Resolve Stroke Disparities In Latin America. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.hup11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Reducing the burden stroke in Latin America (LATAM) is imperative. Stroke remains the first or second leading cause of death in LATAM. The Declaration of Gramado crafted in 2018 established priorities for stroke care in the region. Understanding the design and implementation of acute stroke systems of care at a local level is critical to guide health policy, clinical research, and education resources. Young neurologists are at the forefront of these efforts. ALATAC (Alianza joven LATinoamericana contra el ACv) is an organization of young neurologists in LATAM that uses innovative online communication strategies (social media and instant messaging) to examine and resolve disparities in stroke care in the region.
Methods:
An 11-question survey was sent to 76 members of ALATAC via email and instant messaging (WhatsApp). The survey queried demographic, geographic information, acute stroke treatment and availability of stroke unit data.
Results:
76 young neurologists from LATAM and Spain were surveyed. 54 neurologists from 13 countries took the survey (71% response rate) (see graph). 16 (29.6%) identified as woman and 38 (70.4%) as man. 43 (79.6%) are between 31-40 years of age. 31 (57.4%) practice in more than 1 hospital and 21 (38.9%) do not have a stroke unit in their hospitals. Each neurologist sees a mean of 10 stroke patients per week (range 0-40); the majority had access to intravenous thrombolytics 53 (98.1%), but 12 (22.2%) do not have mechanical thrombectomy available at their hospitals.
Conclusions:
ALATAC is professional movement designed to examine and resolve stroke disparities via new communication technologies enabling real time collaboration. Future ALATAC efforts will develop peer to peer mentorship, networking, clinical research, and implementation of evidence-based medicine aiming to reduce stroke burden in LATAM. This study provides introductory, baseline data to better define the stroke care in LATAM
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Khan M, Arauz A, Uluduz D, Barboza MA, Duman T, Cano-Nigenda V, Awan S, Wasay M. Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis. Cerebrovasc Dis 2022; 52:393-400. [PMID: 36566747 DOI: 10.1159/000527155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/09/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) associated with pregnancy and puerperium has long been recognized, with poor information in terms of functional outcomes. Our objective was to analyze risk factors, clinical, imaging, and laboratory variables to predict functional outcome and death in this population. METHODS CVT registries from three referral centers from Pakistan, Turkey, and Mexico, recruiting prospective cases, were combined for CVT associated with pregnancy or puerperium. Datasets and variables were standardized. Demographic characteristics, presentation, risk factors, and functional outcomes in pregnancy/puerperium-related CVT were analyzed. Binary logistic regression was used to assess predictors of outcome. The main outcome was modified Rankin score >2 at 30 days and mortality at 30 days. RESULTS Five hundred fifty-three cases (median age 28 years [IQR 23-34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified. Predictors of poor outcome (mRS >2) were encephalopathy (OR 12.8, p < 0.001), cases from Mexican origin (OR 3.1, p = 0.004), fever/puerperal infection (OR 2.7, p = 0.02), and anemia (OR 2.2, p = 0.01). Cases from Mexican origin (OR 12.0, p = 0.003) and Encephalopathy (OR 7.7, p < 0.001), presented with the highest mortality association in the final adjusted model. DISCUSSION/CONCLUSION In CVT associated with pregnancy and puerperium, encephalopathy, fever/puerperal infection, and anemia are associated with bad functional outcomes, meanwhile encephalopathy and cases from Mexican origin with higher mortality in the acute (30-days) of CVT onset. Anemia and infection are potential reversible predictors of poor outcome that clinicians should be aware of in order to prevent poor outcomes in these patients.
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Affiliation(s)
- Maria Khan
- Rashid Hospital, Dubai, United Arab Emirates
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico
| | - Derya Uluduz
- Neurology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica
| | - Taskin Duman
- Department of Neurology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico
| | - Safia Awan
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Mohammad Wasay
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
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López-Mena D, García-Grimshaw M, Saldivar-Dávila S, Hernandez-Vanegas LE, Saniger-Alba MDM, Gutiérrez-Romero A, Carrillo-Mezo R, Valdez-Ruvalcaba HE, Cano-Nigenda V, Flores-Silva FD, Cantú-Brito C, Santibañez-Copado AM, Diaz-Ortega JL, Ceballos-Liceaga SE, Murillo-Bonilla LM, Sepulveda-Núñez AI, García-Talavera V, Gonzalez-Guerra E, Cortes-Alcala R, Lopez-Gatell H, Carbajal-Sandoval G, Reyes-Terán G, Valdés-Ferrer SI, Arauz A. Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study. Neurology 2022; 98:e1933-e1941. [PMID: 35277439 PMCID: PMC9141628 DOI: 10.1212/wnl.0000000000200388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Information on stroke among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines remains scarce. We report stroke incidence as an adverse event following immunization (AEFI) among recipients of 79,399,446 doses of 6 different SARS-CoV-2 vaccines (BNT162b2, ChAdOx1 nCov-19, Gam-COVID-Vac, CoronaVac, Ad5-nCoV, and Ad26.COV2-S) between December 24, 2020, and August 31, 2021, in Mexico. METHODS This retrospective descriptive study analyzed stroke incidence per million doses among hospitalized adult patients (≥18 years) during an 8-month interval. According to the World Health Organization, AEFIs were defined as clinical events occurring within 30 days after immunization and categorized as either nonserious or serious, depending on severity, treatment, and hospital admission requirements. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral venous thrombosis (CVT) cases were collected through a passive epidemiologic surveillance system in which local health providers report potential AEFI to the Mexican General Board of Epidemiology. Data were captured with standardized case report formats by an ad hoc committee appointed by the Mexican Ministry of Health to evaluate potential neurologic AEFI against SARS-COV-2. RESULTS We included 56 patients (31 female patients [55.5%]) for an overall incidence of 0.71 cases per 1,000,000 administered doses (95% CI 0.54-0.92). Median age was 65 years (interquartile range [IQR] 55-76 years); median time from vaccination to stroke (of any subtype) was 2 days (IQR 1-5 days). In 27 (48.2%) patients, the event was diagnosed within the first 24 hours after immunization. The most frequent subtype was AIS in 43 patients (75%; 0.54 per 1,000,000 doses, 95% CI 0.40-0.73), followed by ICH in 9 (16.1%; 0.11 per 1,000,000 doses, 95% CI 0.06-0.22) and SAH and CVT, each with 2 cases (3.6%; 0.03 per 1,000,000 doses, 95% CI 0.01-0.09). Overall, the most common risk factors were hypertension in 33 (58.9%) patients and diabetes in 22 (39.3%). Median hospital length of stay was 6 days (IQR 4-13 days). At discharge, functional outcome was good (modified Rankin Scale score 0-2) in 41.1% of patients; in-hospital mortality rate was 21.4%. DISCUSSION Stroke is an exceedingly rare AEFI against SARS-CoV-2. Preexisting stroke risk factors were identified in most patients. Further research is needed to evaluate causal associations between SARS-COV-2 vaccines and stroke.
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Affiliation(s)
- Diego López-Mena
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Miguel García-Grimshaw
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Sergio Saldivar-Dávila
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Laura Elena Hernandez-Vanegas
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - María Del Mar Saniger-Alba
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Alonso Gutiérrez-Romero
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Roger Carrillo-Mezo
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Hector Eduardo Valdez-Ruvalcaba
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Vanessa Cano-Nigenda
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Fernando Daniel Flores-Silva
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Carlos Cantú-Brito
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ana María Santibañez-Copado
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Jose-Luis Diaz-Ortega
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Santa Elizabeth Ceballos-Liceaga
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Luis Manuel Murillo-Bonilla
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ana Isabel Sepulveda-Núñez
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Verónica García-Talavera
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Eduardo Gonzalez-Guerra
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ricardo Cortes-Alcala
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Hugo Lopez-Gatell
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Guillermo Carbajal-Sandoval
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Gustavo Reyes-Terán
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Sergio Iván Valdés-Ferrer
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Antonio Arauz
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
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10
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Cano-Nigenda V, Castellanos-Pedroza E, Manrique-Otero D, Méndez B, Menéndez-Manjarrez MF, Toledo-Treviño R, Calderón M, Arauz A. Barriers to Optimal Acute Management of Stroke: Perspective of a Stroke Center in Mexico City. Front Neurol 2021; 12:690946. [PMID: 34950095 PMCID: PMC8688839 DOI: 10.3389/fneur.2021.690946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke is a leading cause of death and disability worldwide, particularly in low- and middle-income countries. We aimed to identify the main barriers to optimal acute management of stroke in a referral center. Methods: Demographic data was collected from patients assessed with acute stroke in the emergency department of the Instituto Nacional de Neurología y Neurocirugía (INNN) from January to June 2019. Additionally, a telephone interview was conducted with patients/primary caregiver to know which they considered the main reason for the delay in arrival at INNN since the onset of stroke. Results: 116 patients were assessed [age 65 ± 15 years, 67 (57.8%) men]. Patients consulted other facilities prior to arrival at INNN in 59 (50.9%) cases (range of hospitals visited 1-4), 83 (71.6%) arrived in a private car, with prenotification in only 4 (3.4%) of the total sample. The mean onset-to-door time was 17 h (45 min-10 days). Telephone interviews were done in 61 patients/primary caregivers, stating that they consider the multiple evaluations in other facilities [n = 26/61 (42.6%)] as the main reason for delay in arrival at the ED, followed by ignorance of stroke symptoms and treatment urgency [n = 21/61 (34.4%)]. Conclusion: In this small, retrospective, single center study, the main prehospital barrier to optimal acute management of stroke in a developing country is multiple medical evaluations prior to the patient's transport to a specialized stroke hospital, who mostly arrived in a private car and without prenotification. These barriers can be overcome by strengthening public education and improving patient transfer networks and telemedicine.
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Affiliation(s)
- Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Diana Manrique-Otero
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Beatriz Méndez
- Department of Endovascular Therapy, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Roberto Toledo-Treviño
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Miguel Calderón
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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11
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Toledo-Trevino R, Manrique-Otero D, Castellanos-Pedroza E, Cano-Nigenda V, Alvarado-Bolaños A, Calleja-Castillo J, Arauz A. Foix-Chavany-Marie Syndrome as a Manifestation of Unilateral Opercular Stroke. Eur J Case Rep Intern Med 2021; 8:002462. [PMID: 33987126 DOI: 10.12890/2021_002462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Foix-Chavany-Marie syndrome (FCMS) is a type of pseudobulbar palsy that affects facio-pharyngo-glosso-masticatory muscles. Materials and Methods A 62-year-old man was admitted to the emergency department after 9 hours of acute dysarthria and dysphagia. MRI showed restricted diffusion in the right operculum on diffusion-weighted imaging (DWI). No thrombolytic therapy was given. The patient had a history of mechanical aortic valve replacement under anticoagulation with a vitamin K antagonist. Work-up demonstrated suboptimal levels of INR. Due to severe dysphagia during hospitalization, a percutaneous endoscopic gastrostomy (PEG) was performed. Results The patient was discharged 5 days later, with a modified Rankin scale (mRs) score of 3, and secondary stroke prevention. He had achieved an excellent functional outcome (mRs 1) at 6-month follow-up. Conclusion Our patient had a satisfactory recovery due to prompt diagnosis, secondary stroke prevention, and compliance with treatment. LEARNING POINTS In the presence of acute dysarthria and dysphagia, Foix-Chavany-Marie syndrome (FCMS) should be considered.FCMS may occur in the presence of unilateral opercular stroke.Swallowing and speech therapy play an essential role in rehabilitation after the acute setting.
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Affiliation(s)
- Roberto Toledo-Trevino
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Diana Manrique-Otero
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Vanessa Cano-Nigenda
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Alonso Alvarado-Bolaños
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Juan Calleja-Castillo
- Emergency Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Antonio Arauz
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
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12
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Matus-Mayorga R, Barrera-Vargas A, Rull-Gabayet M, Aguirre-Aguilar E, Valdez-López M, Espinoza-Lira F, Ramos-Ventura C, Cano-Nigenda V, Barboza MA, Merayo-Chalico J, Arauz A. Risk factors for ischemic antiphospholipid syndrome: A case-control study. Clin Neurol Neurosurg 2021; 202:106492. [PMID: 33540176 DOI: 10.1016/j.clineuro.2021.106492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to identify clinical and laboratory risk factors for ischemic stroke (IS) in primary antiphospholipid syndrome (APS) patients. MATERIALS AND METHODS We performed a case-control study with consecutive primary APS patients divided into two groups, those who presented with IS, vs. those with no history of stroke. Demographics, vascular risk factors, therapeutic approaches, laboratory, imaging and functional outcomes were recorded. RESULTS Fifty-three confirmed primary APS patients with IS and sixty-six non-stroke primary APS controls were recruited. Most patients were female (65.5 %), with a median age of 33 years. The main vascular risk factors for primary APS-associated stroke were hypertension (11.3 %), diabetes (11.3 %) and hypercholesterolemia (9.4 %). Among patients with stroke, median NIHSS score was 6; 15.1 % of these patients presented a recurrent stroke, and 88.8 % had a good functional outcome at the final follow-up. Positive lupus anticoagulant (OR = 6.1, 95 %CI 2.7-13.5), anti-β2 glycoprotein IgG (OR = 3.6, 95 %CI 1.7-7.9), and anticardiolipin IgG (OR = 2.8, 95 %CI 1.3-5.9) were more prevalent in non-stroke primary APS, with a triple-positive antibody presence in 46.4 % of controls vs. 22.2 % of patients with stroke (OR = 3.0, 95 %CI 1.3-6.7). At the time of the index event (arterial or venous), 14 known primary APS patients were using vitamin K antagonists, but only 35.7 % of them had achieved therapeutic INR. CONCLUSION Patients with primary APS and IS have similar vascular risk factors and lower antibody positivity than those with extracranial thrombosis.
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Affiliation(s)
- Roxana Matus-Mayorga
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico City, Mexico
| | - Ana Barrera-Vargas
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marina Rull-Gabayet
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eduardo Aguirre-Aguilar
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Martín Valdez-López
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Espinoza-Lira
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico City, Mexico
| | - Cristina Ramos-Ventura
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico City, Mexico
| | - Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico City, Mexico
| | - Miguel A Barboza
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico City, Mexico; Neurosciences Department, Hospital Dr Rafael A. Calderón Guardia, CCSS, San Jose, Costa Rica
| | - Javier Merayo-Chalico
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico City, Mexico
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13
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Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, Calleja P, Ostos F, González-Ortega G, Fuentes B, Alonso de Leciñana M, Díez-Tejedor E, García-Madrona S, Masjuan J, DeFelipe A, Turc G, Gonçalves B, Domigo V, Dan GA, Vezeteu R, Christensen H, Christensen LM, Meden P, Hajdarevic L, Rodriguez-Lopez A, Díaz-Otero F, García-Pastor A, Gil-Nuñez A, Maslias E, Strambo D, Werring DJ, Chandratheva A, Benjamin L, Simister R, Perry R, Beyrouti R, Jabbour P, Sweid A, Tjoumakaris S, Cuadrado-Godia E, Campello AR, Roquer J, Moreira T, Mazya MV, Bandini F, Matz K, Iversen HK, González-Duarte A, Tiu C, Ferrari J, Vosko MR, Salzer HJF, Lamprecht B, Dünser MW, Cereda CW, Quintero ÁBC, Korompoki E, Soriano-Navarro E, Soto-Ramírez LE, Castañeda-Méndez PF, Bay-Sansores D, Arauz A, Cano-Nigenda V, Kristoffersen ES, Tiainen M, Strbian D, Putaala J, Lip GYH. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke 2020; 51:e254-e258. [PMID: 32787707 PMCID: PMC7359900 DOI: 10.1161/strokeaha.120.031208] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. 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 Institute 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 Institute 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 Institute 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.
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Affiliation(s)
- George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom (G.G.)
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China (Y.G.)
| | - Wencheng Li
- Department of Urology (W.L.), Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, China
| | - Jing Xiong
- Department of Nephrology (J.X.), Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, China
| | - Patricia Calleja
- Department of Neurology and Stroke Center, Doce de Octubre University Hospital, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (P.C., F.O., G.G.-O.)
| | - Fernando Ostos
- Department of Neurology and Stroke Center, Doce de Octubre University Hospital, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (P.C., F.O., G.G.-O.)
| | - Guillermo González-Ortega
- Department of Neurology and Stroke Center, Doce de Octubre University Hospital, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (P.C., F.O., G.G.-O.)
| | - Blanca Fuentes
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain (B.F., M.A.d.L., E.D.-T.)
| | - María Alonso de Leciñana
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain (B.F., M.A.d.L., E.D.-T.)
| | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain (B.F., M.A.d.L., E.D.-T.)
| | - Sebastian García-Madrona
- Department of Neurology and Stroke Centre, Ramón y Cajal University Hospital, IRYCIS Health Research Institute, Madrid, Spain (S.G.-M., J.M., A.D.)
| | - Jaime Masjuan
- Department of Neurology and Stroke Centre, Ramón y Cajal University Hospital, IRYCIS Health Research Institute, Madrid, Spain (S.G.-M., J.M., A.D.)
| | - Alicia DeFelipe
- Department of Neurology and Stroke Centre, Ramón y Cajal University Hospital, IRYCIS Health Research Institute, Madrid, Spain (S.G.-M., J.M., A.D.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, and FHU Neurovasc, France (G.T., B.G., V.D.)
| | - Bruno Gonçalves
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, and FHU Neurovasc, France (G.T., B.G., V.D.).,Intensive Care Unit, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil (B.G.)
| | - Valerie Domigo
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, and FHU Neurovasc, France (G.T., B.G., V.D.)
| | - Gheorghe-Andrei Dan
- Colentina University Hospital, Medicine Faculty, University of Medicine "Carol Davila"-Bucharest, Romania (G.-A.D., R.V.)
| | - Roxana Vezeteu
- Colentina University Hospital, Medicine Faculty, University of Medicine "Carol Davila"-Bucharest, Romania (G.-A.D., R.V.)
| | - Hanne Christensen
- Bispebjerg Hospital & University of Copenhagen, Denmark (H.C., L.M.C., P.M., L.H.)
| | | | - Per Meden
- Bispebjerg Hospital & University of Copenhagen, Denmark (H.C., L.M.C., P.M., L.H.)
| | - Lejla Hajdarevic
- Bispebjerg Hospital & University of Copenhagen, Denmark (H.C., L.M.C., P.M., L.H.)
| | - Angela Rodriguez-Lopez
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Fernando Díaz-Otero
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Andrés García-Pastor
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Antonio Gil-Nuñez
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Errikos Maslias
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo)
| | - Davide Strambo
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo)
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Arvind Chandratheva
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Laura Benjamin
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Robert Simister
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Richard Perry
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Rahma Beyrouti
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (P.J., A.S., S.T.)
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (P.J., A.S., S.T.)
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (P.J., A.S., S.T.)
| | - Elisa Cuadrado-Godia
- Stroke Unit, Department of Neurology, Hospital del Mar (E.C.-G., A.R.C., J.R.).,Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain (E.C.-G., A.R.C., J.R.)
| | - Ana Rodríguez Campello
- Stroke Unit, Department of Neurology, Hospital del Mar (E.C.-G., A.R.C., J.R.).,Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain (E.C.-G., A.R.C., J.R.)
| | - Jaume Roquer
- Stroke Unit, Department of Neurology, Hospital del Mar (E.C.-G., A.R.C., J.R.).,Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain (E.C.-G., A.R.C., J.R.)
| | - Tiago Moreira
- Department of Clinical Neuroscience (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden.,Department of Neurology (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden
| | - Michael V Mazya
- Department of Clinical Neuroscience (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden.,Department of Neurology (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden
| | - Fabio Bandini
- Department of Neurology, San Paolo Hospital, Savona, Italy (F.B.)
| | - Karl Matz
- Landesklinikum Mödling, Neurologische Abteilung und Donau-Universität Krems, Zentrum für Vaskuläre Prävention, Krems, Austria (K.M.)
| | - Helle K Iversen
- Stroke Centre Rigshospitalet, Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (H.K.I.)
| | - Alejandra González-Duarte
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a COVID Center, Mexico City (A.G.-D.)
| | - Cristina Tiu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (C.T.).,University Emergency Hospital, Bucharest, Romania (C.T.)
| | - Julia Ferrari
- Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (J.F.)
| | - Milan R Vosko
- Department of Neurology 2 (M.R.V.), Kepler University Hospital, Linz, Austria
| | - Helmut J F Salzer
- Department of Pulmonary Medicine (H.J.F.S., B.L.), Kepler University Hospital, Linz, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine (H.J.F.S., B.L.), Kepler University Hospital, Linz, Austria
| | - Martin W Dünser
- Department of Anesthesiology and Intensive Care Medicine, Johannes Kepler University, Linz, Austria (M.W.D.)
| | - Carlo W Cereda
- Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | | | - Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (E.K.)
| | - Eduardo Soriano-Navarro
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Luis Enrique Soto-Ramírez
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Paulo F Castañeda-Méndez
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Daniela Bay-Sansores
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City (A.A., V.C.-N.)
| | - Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City (A.A., V.C.-N.)
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Norway (E.S.K.).,Department of General Practice, HELSAM, University of Oslo (E.S.K.)
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital, Finland (M.T., D. Strbian, J.P.)
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Finland (M.T., D. Strbian, J.P.)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Finland (M.T., D. Strbian, J.P.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom (G.Y.H.L.).,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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14
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Soriano-Navarro E, Cano-Nigenda V, Menéndez-Manjarrez F, Farington-Terrero E, Méndez-Gallardo JJ, García-Irigoyen A, Arauz A. Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis. Eur J Case Rep Intern Med 2020; 7:001560. [PMID: 32665923 PMCID: PMC7350954 DOI: 10.12890/2020_001560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10–15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment. Patient and methods We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed. Results At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3. Discussion Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres. LEARNING POINTS
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Affiliation(s)
- Eduardo Soriano-Navarro
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Vanessa Cano-Nigenda
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Esmirna Farington-Terrero
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Juan José Méndez-Gallardo
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.,Endovascular Stroke Therapy, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Alejandro García-Irigoyen
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Antonio Arauz
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
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15
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Delgado-García G, Cano-Nigenda V, Abundes-Corona A, Carrillo-Loza K, Calleja-Castillo J, Flores-Rivera J. Opisthotonus (arc de cercle) in anti-NMDAR encephalitis. Arq Neuropsiquiatr 2018; 76:426. [PMID: 29972427 DOI: 10.1590/0004-282x20180047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/17/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Guillermo Delgado-García
- Subdirección de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Vanessa Cano-Nigenda
- Subdirección de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Arturo Abundes-Corona
- Subdirección de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Karina Carrillo-Loza
- Subdirección de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.,Clínica de Enfermedades Desmielinizantes, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Juan Calleja-Castillo
- Subdirección de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - José Flores-Rivera
- Subdirección de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.,Clínica de Enfermedades Desmielinizantes, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
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16
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Chiquete E, Torres-Octavo B, Cano-Nigenda V, Valle-Rojas D, Dominguez-Moreno R, Tolosa-Tort P, Florez-Cardona JA, Flores-Silva F, Reyes-Melo I, Higuera-Calleja J, Garcia-Ramos G, Cantu-Brito C. [Characterisation of factors associated with carotid stenosis in a population at high risk]. Rev Neurol 2014; 58:541-547. [PMID: 24915030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Moderate to severe stenosis is the less prevalent among the forms of carotid atherosclerotic disease), but it carries a high risk of ischaemic stroke. AIM To characterise factors associated with moderate to severe carotid stenosis in a high-risk population. PATIENTS AND METHODS We performed an analysis on traditional risk factors associated with carotid stenosis ≥50% in 533 patients who received Doppler ultrasound due to a history of stroke (34%) or who had = 2 of the risk factors: age ≥55 years (86%), hypertension (65%), dyslipidemia (52%), obesity (42%), diabetes (40%) or smoking (40%). RESULTS The prevalence of carotid stenosis ≥50% was 7.1%, symptomatic (associated with stroke in congruent territory) in 5.6%, bilateral in 2.1% and bilateral symptomatic in 1.5%. A 36.8% of patients had moderate to severe load (≥4) of atherosclerotic plaques (25.9% moderate: 4-6 plaques, and 10.9% severe: ≥7 plaques). By multivariate analysis we identified the age ≥75 years, dyslipidemia, and smoking as factors independently associated with carotid stenosis ≥50%, and hypertension and smoking with symptomatic stenosis. The number of risk factors was strongly associated with the prevalence of carotid stenosis. Notably, neither diabetes nor obesity explained the degree of moderate to severe carotid stenosis. CONCLUSIONS As forms of carotid atherosclerotic disease, moderate to severe stenosis is less frequent than a high burden of atherosclerotic plaques. Advanced age, smoking, dyslipidemia and hypertension are the main traditional risk factors associated with the degree of carotid stenosis.
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Affiliation(s)
- Erwin Chiquete
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
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