Chest CT has a potential role in the diagnosis, detection of complications, and prognostication of coronavirus disease 2019 (COVID-19). Implementation of appropriate precautionary safety measures, chest CT protocol optimization, and a standardized reporting system based on the pulmonary findings in this disease will enhance the clinical utility of chest CT. However, chest CT examinations may lead to both false-negative and false-positive results. Furthermore, the added value of chest CT in diagnostic decision making is dependent on several dynamic variables, most notably available resources (real-time reverse transcription-polymerase chain reaction [RT-PCR] tests, personal protective equipment, CT scanners, hospital and radiology personnel availability, and isolation room capacity) and the prevalence of both COVID-19 and other diseases with overlapping manifestations at chest CT. Chest CT is valuable to detect both alternative diagnoses and complications of COVID-19 (acute respiratory distress syndrome, pulmonary embolism, and heart failure), while its role for prognostication requires further investigation. The authors describe imaging and managing care of patients with COVID-19, with topics including (a) chest CT protocol, (b) chest CT findings of COVID-19 and its complications, (c) the diagnostic accuracy of chest CT and its role in diagnostic decision making and prognostication, and (d) reporting and communicating chest CT findings. The authors also review other specific topics, including the pathophysiology and clinical manifestations of COVID-19, the World Health Organization case definition, the value of performing RT-PCR tests, and the radiology department and personnel impact related to performing chest CT in COVID-19. ©RSNA, 2020.

https://pubs.rsna.org/doi/pdf/10.1148/rg.2020200159

Chest CT in COVID-19: What the Radiologist Needs to Know.

INTRODUCTION: Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection, anecdotal reports indicate a falling rate of new ischemic stroke diagnoses. We conducted an exploratory single-center analysis to estimate the change in number of new stroke diagnoses in our region, and evaluate the proximate reasons for this change during the COVID-19 pandemic at a tertiary care center in New Jersey. PATIENTS AND METHODS: A Comprehensive Stroke Center prospective cohort was retrospectively analyzed for the number of stroke admissions, demographic features, and short-term outcomes 5 months prior to 3/1/2020 (pre-COVID-19), and in the 6 weeks that followed (COVID-19 period). The primary outcome was the number of new acute stroke diagnoses before and during the COVID-19 period, as well as the potential reasons for a decline in the number of new diagnoses. RESULTS: Of the 328 included patients, 53 (16%) presented in the COVID-19 period. There was a mean fall of 38% in new stroke diagnoses (mean 1.13/day [SD 1.07] from 1.82/day [SD 1.38], p<0.01), which was related to a 59% decline in the number of daily transfers from referral centers (p<0.01), 25% fewer telestroke consultations (p=0.08), and 55% fewer patients presenting directly to our institution by private vehicle (p<0.01) and 29% fewer patients through emergency services (p=0.09). There was no significant change in the monthly number of strokes due to large vessel occlusion (LVO), however the proportion of new LVOs nearly doubled in the COVID-19 period (38% vs. 21%, p=0.01). CONCLUSIONS: The observations at our tertiary care center corroborate anecdotal reports that the number of new stroke diagnoses is falling, which seems related to a smaller proportion of patients seeking healthcare services for milder symptoms. These preliminary data warrant validation in larger, multi-center studies.

Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center.

Coronavirus disease 2019 (COVID-19) has become a global health crisis of our time. The disease arises from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to angiotensin-converting enzyme 2 (ACE2) receptors on host cells for its internalization. COVID-19 has a wide range of respiratory symptoms from mild to severe and affects several other organs, increasing the complexity of the treatment. There is accumulating evidence to suggest that SARS-CoV-2 can target the nervous system. In this review, we provide an account of the COVID-19 central nervous system (CNS) manifestations. A broad spectrum of the CNS manifestations including headache, impaired consciousness, delirium, loss of smell and taste, encephalitis, seizures, strokes, myelitis, acute disseminated encephalomyelitis, neurogenic respiratory failure, encephalopathy, silent hypoxemia, generalized myoclonus, neuroleptic malignant syndrome and Kawasaki syndrome has been reported in patients with COVID-19. CNS manifestations associated with COVID-19 should be considered in clinical practice. There is a need for modification of current protocols and standing orders to provide better care for COVID-19 patients presenting with neurological symptoms.

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Peripheral Nervous System Manifestations Associated with COVID-19.

BackgroundThe COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.AimsWe sought to measure the global impact of the COVID-19 pandemic on the volumes for m...

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Global impact of COVID-19 on stroke care.

OBJECTIVE: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke We conducteda systematic review and meta-analysis to evaluate the aforementioned considerations METHODS: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS-CoV-2 infection status We used a random-effects model Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI) RESULTS: We identified 18 cohort studies including 67,845 patients Among patients with SARS-CoV-2, 1 3% (95%CI:0 9-1 6%;I(2) =87%) were hospitalized for cerebrovascular events, 1 1% (95%CI:0 8-1 3%;I(2) =85%) for ischemic stroke, and 0 2% (95%CI:0 1-0 3%;I(2) =64%) for hemorrhagic stroke Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3 58,95%CI:1 43-8 92;I(2) =43%) and cryptogenic stroke (OR=3 98,95%CI:1 62-9 77;I(2) =0%) Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls (OR=1 39, 95%CI:1 04-1 86;I(2) =0%) SARS-CoV-2 infection status was not associated with the likelihood of receiving intravenous thrombolysis (OR=1 42,95%CI:0 65-3 10;I(2) =0%) or endovascular thrombectomy (OR=0 78,95%CI:0 35-1 74;I(2) =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic Odds for in-hospital mortality were higher among SARS-CoV-2stroke patients compared to non-infected contemporary or historical stroke patients (OR=5 60,95%CI:3 19-9 80;I(2) =45%) INTERPRETATION: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke, and potentially cryptogenic stroke in particular It may also be related to an increased mortality risk This article is protected by copyright All rights reserved

The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-analysis

In December 2019, coronavirus disease 2019 (COVID-19), an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused an international outbreak. The World Health Organization designated this as a global pandemic on March 11, 2020, with over 200 countries affected worldwide. As of April 24, 2020, there were 2 790 986 patients with confirmed COVID-19 and 195 775 deaths worldwide, with the United States, Spain, Italy, France, Germany, United Kingdom, Turkey, and Iran surpassing China in the number of confirmed cases. In a consecutive series of 221 patients with confirmed COVID-19 admitted to a hospital in Wuhan, China, acute ischemic stroke occurred in 11(5%) of patients with a broad range of stroke subtypes. These patients with stroke were older, more likely to have cardiovascular risk factors, presenting with severe COVID-19 with multiple organ involvement. Of note, presence of COVID-19 in these patients does not imply that COVID-19 was the mechanism leading to the patient’s stroke. Shortages of Personal Protective Equipment (PPE) such as N95 masks, facial shields, hand sanitizer, and cleansing wipes have presented a major challenge in the allocation of resources, as healthcare workers are frontline in the treatment of these patients. Redeployment of clinical staff, nursing, stroke and neurocritical care specialists to care for patients with COVID-19 may create staffing shortages for dedicated stroke care. In an effort to mitigate the spread of COVID-19 to neuroscience healthcare workers, their patients, and their families, and to optimize allocation of healthcare resources, we present a modified algorithm to acute ischemic large vessel occlusion stroke workflow in the era of the COVID-19 pandemic. This guidance statement is based on shared best practices, consensus among academic and nonacademic practicing vascular and interventional neurologists, literature review, and would be adapted to the available resources of a local institution. The patients with acute stroke are a vulnerable group to address because these patients often come emergently from the community with little information. Radical changes are felt to be necessary to optimize the safety of the providing team and our patients, limit unnecessary tests, conserve PPE resources and mechanical ventilator usage. This document divides into the following: prehospital phase to the Emergency Department (ED), prethrombectomy procedure, thrombectomy intraprocedure, and postreperfusion therapy phases (Table).

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Mechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams: A Guidance Statement From the Society of Vascular and Interventional Neurology.

Aneurysmal subarachnoid hemorrhage (SAH) patients require frequent neurological examinations, neuroradiographic diagnostic testing and lengthy intensive care unit stay. Previously established SAH treatment protocols are impractical to impossible to adhere to in the current COVID-19 crisis due to the need for infection containment and shortage of critical care resources, including personal protective equipment (PPE). Centers need to adopt modified protocols to optimize SAH care and outcomes during this crisis. In this opinion piece, we assembled a multidisciplinary, multicenter team to develop and propose a modified guidance algorithm that optimizes SAH care and workflow in the era of the COVID-19 pandemic. This guidance is to be adapted to the available resources of a local institution and does not replace clinical judgment when faced with an individual patient.

Sherry Hsiang Yi Chou

Papers

Mechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams: A Guidance Statement From the Society of Vascular and Interventional Neurology.

Subarachnoid hemorrhage guidance in the era of the COVID-19 pandemic - An opinion to mitigate exposure and conserve personal protective equipment.