Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Background and purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

The link between weight shift asymmetry and gait disturbances in chronic hemiparetic stroke patients

Andrzej Szopa,1 Małgorzata Domagalska-Szopa,2 Anetta Lasek-Bal,3 Amadeusz Żak3 1Department of Physiotherapy, 2Department of Medical Rehabilitation, School of Health Sciences in Katowice, 3Department of Neurology, Professor Leszek Giec Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland Introduction: While the asymmetry of body posture and the asymmetrical nature of hemiparetic gait in poststroke (PS) patients are well documented, the role of weight shift asymmetry in gait disorders after stroke remains unclear. Objective: We examined the association of weight-bearing asymmetry (WBA) between paretic and nonparetic lower limbs during quiet standing with the degree of deviation of hemiplegic gait from normal gait evaluated by the Gillette Gait Index (GGI) incorporating 16 distinct clinically important kinematic and temporal parameters in chronic PS patients.Participants and methods: Twenty-two ambulatory patients with chronic stroke aged between 50 and 75 years were included in this study. Fourteen patients had hemiparesis on the nondominant side and 8 on the dominant side. The mean time PS was 2 years and 6 months. The reference group consisted of 22 students from the University of the Third Age presenting no neurological disorders. The examination consisted of posturographic weight-bearing (WB) distribution and 3-dimensional gait analyses.Results: A significant positive relationship between WBA and GGI was revealed. Moreover, we observed a significant negative association between WBA and paretic step length and walking speed. With regard to kinematic data, the range of motion of knee flexion and peak dorsiflexion in the swing phase of the paretic leg were significantly negatively associated with WBA.Conclusion: Although further research is needed to determine a causal link between postural control asymmetry and gait disturbance in hemiplegics, our findings support the inclusion of WB measurements between paretic and nonparetic body sides in early assessment after stroke. Keywords: stroke, weight-bearing, 3DGA, gait disturbances, Gillette Gait Index&nbsp

Supplementary Material for: Early and One-Year Outcomes of Acute Stroke in the Industrial Region of Poland During the Decade 2006–2015: The Silesian Stroke Registry

<b><i>Background:</i></b> Poland, classified as a high-income country, is still considered to have a high cardiovascular risk population. During the last decade, the standards of care in acute stroke (AS) had markedly improved; thus, we aimed to assess whether and how it translated into early and late outcomes. <b><i>Methods:</i></b> Silesian Stroke Registry was created from the administrative database of the public, obligatory, health ­insurer in Poland. The AS cases were selected based on primary diagnosis coded in ICD-10 as I60-I64 for years 2006–2015 (<i>n</i> = 120,844). Index hospitalization together with data on re-hospitalizations, procedures, ambulatory visits, rehabilitation and all-cause deaths in a 1-year follow-up were analyzed. <b><i>Results:</i></b> The rates of admissions per 100,000 adult population varied between 41–47 for haemorrhagic and 257–275 for ischaemic stroke with substantial decrease in almost all age groups except for the oldest patients. In ischaemic stroke, thrombolytic therapy raised from 0 to 8.8% in 2015, along with significant trends of decreasing 30-day (from 20 to 16%) and 12-month (from 35 to 31%) case fatality. In haemorrhagic stroke, case fatality had not changed. After ischaemic stroke, 12-month readmissions due to AS declined from 11–12% in 2006–2009 to 9% in 2010–2014. The percentage of patients benefiting from rehabilitation increased from 24 to 32%. <b><i>Conclusions:</i></b> In a large population of industrial province, we showed recent, positive trends in AS admissions, treatment and 1-year outcomes. Development of stroke unit networks and increase in thrombolytic treatment were at least in part responsible for survival improvement and reduction of recurrence of AS. However, case-fatality and stroke recurrence remain high compared to those of other developed countries