COVID-19 Era Stroke Service: Virtually Normal
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Reflections from the COVID Pandemic (A Iranzo and M Rosenfeld, Section Editors)
COVID-19 Era Stroke Service: Virtually Normal Nicholas Liaw, MD, PhD* David S. Liebeskind, MD Address * Department of Vascular Neurology, University of California Los Angeles, 635 Charles E Young Drive South, Suite 225, Los Angeles, CA, 90095-7334, USA Email: [email protected]
Published online: 8 October 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Reflections from the COVID Pandemic Keywords Acute ischemic stroke I COVID-19 I Pandemic I Zoom conferences I Reflections
Abstract Objective To characterize my experience in the inpatient stroke service in an amusing fashion. Background The COVID-19 pandemic broke out during my time as a stroke fellow. It was a unique experience. Methods A non-exhaustive review of my memories as a stroke fellow during the COVID-19 pandemic was performed. I sat down and wrote the article. Then, I illustrated the figure. Results All results are not statistically significant unless otherwise noted. Conclusions Zoom conferences are a promising technology for stroke services. Further studies are needed to further elucidate their benefits and drawbacks.
The stroke team was restive as we gathered in the conference room for the daily table rounds, as we always do. Two residents, a senior resident, and myself, the stroke fellow, all wearing surgical masks. We gathered in front of the computer and connect to Zoom teleconferencing. The face of our stroke attending popped up on the screen, his background imperfectly masked by the app with an incongruous photo of palm trees (Fig. 1). “My hair has been growing out with the lockdown,” quipped our attending, in his usual rapid speech. “And, you can’t tell from the Zoom cams since it cuts off part of your hair with the background mask.” “You don’t see yourself in the mirror in the morning?” “I don’t use a mirror. Were there any new consults overnight?”
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Fig. 1. The COVID-19 era stroke team in their natural habitat
The resident launched into the case presentation of the new patient: “We were consulted for prognosis of a COVID-19 positive patient after finding acute strokes in the course of altered mental status workup. This is a 77 year old male with a past medical history of coronary artery disease status post bypass, diabetes type 2, and hypertension. He was transferred from an outside hospital for convalescent plasma treatment after a prolonged hospitalization for respiratory failure requiring intubation from COVID-19 infection. He unfortunately suffered multi-system failure, including acute respiratory distress syndrome, renal failure requiring hemodialysis, liver injury, and sepsis requiring pressor support. When he was transferred to our hospital the patient remained obtunded after removing sedation. MRI of the brain was done to look for a cause.” The MRI was brought up on the screen, revealing multiple acute strokes. The
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