Acute stroke care during the COVID-19 pandemic: difficult, but not impossible!
- PDF / 643,139 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 88 Downloads / 160 Views
LETTER TO THE EDITOR
Acute stroke care during the COVID‑19 pandemic: difficult, but not impossible! Sofia Maldonado Slootjes1 · Frank Hammer2 · Jonathan Leempoel1 · André Peeters1 Received: 8 May 2020 / Accepted: 29 June 2020 © Belgian Neurological Society 2020
Keywords Stroke · COVID-19 · Coronavirus · Carotid T occlusion · Code stroke Amid the coronavirus disease 2019 (COVID-19) pandemic, neurologists have been confronted with unprecedented situations, among which acute stroke management in COVID-19 patients. To the best of our knowledge, this is the first report of protected code stroke in Belgium. A 74-year-old patient, while hospitalized for a COVID-19 pneumonia, experienced sudden-onset left-sided hemiplegia and aphasia. Two hours after symptom onset, an in-hospital code stroke was activated. A neurologist in personal protection equipment (PPE) consisting of mask, goggles, gown and gloves [1], evaluated the patient and documented a National Institutes of Health Stroke Scale (NIHSS) of 16, rapidly deteriorating to 25. Neuroimaging in the COVID-19 section of the radiology department showed no abnormality on the non-contrast computed tomography (NCCT) of the brain but CT angiography revealed a right carotid T occlusion. Intravenous thrombolysis with alteplase was administered within 3 h of symptom onset. The patient was then promptly transferred to the interventional radiology suite dedicated to COVID-19 patients to undergo endovascular thrombectomy (EVT). EVT by thrombus aspiration was performed under general anesthesia, using a Cello 9F balloon guide catheter for proximal flow control and a Sofia 6F catheter for distal aspiration. Complete recanalization of the carotid artery (modified treatment in cerebral ischemia (mTICI) grade 3) by first-pass thrombus aspiration was achieved 4 h and 30 min after symptom onset (Fig. 1). The patient was closely monitored in a COVID-19 Intensive Care unit. The
neurological symptoms resolved as reflected by a NIHSS of 1 at 72 h after symptom onset. In a health care system overwhelmed by COVID-19 patients, acute stroke management represents a major challenge. Awareness of stroke symptoms may be reduced, patients are experiencing fear of hospitals and stay at home, although they require urgent medical attention, while inhospital logistical pathways have changed. For instance, PPE regulations have been implemented to reduce nosocomial infection rate, which has been reported to be as high as 41.3% [2]. However necessary, they may prove to be timeconsuming in a code stroke setting. Despite these difficulties, successful outcome may be achieved, such as in our case. Since cerebrovascular disease has been observed in 5.9% of COVID-19 patients [3], this situation will not be infrequent. The implementation of protected code stroke is, therefore, essential [1, 4, 5]. Treating patients early after symptom onset remains the cornerstone of stroke management and stroke physicians should continue to pursue this goal during the COVID-19 pandemic.
* André Peeters andre.peeters@uclouvain
Data Loading...
