Stefania Maffei (Italy)
Ospedale Civile di Baggiovara, AOU di Modena. Stroke Unit – Neurology Clinic, Department of NeuroscienceAuthor Of 2 Presentations
COGNITIVE DECLINE IN LATE-ONSET EPILEPSY OF UNDEFINED ETIOLOGY: A LONGITUDINAL COHORT STUDY
- Michele Romoli (Italy)
Abstract
Background and Aims:
Symptomatic intraparenchymal hemorrhage (sICH) and major bleeding can be fatal complications of intravenous thrombolysis (IVT) for acute ischemic stroke. We investigated the impact of early fibrinogen depletion after IVT on major bleeding events.
Methods:
This multicenter observational study enrolled consecutive patients receiving IVT for acute ischemic stroke at 6 Italian centers, undergoing fibrinogen concentration assessment at baseline, 2 hours and 6 hours after IVT. Fibrinogen depletion was defined as a reduction below 200 mg/dl after 2 hours from IVT, or as a reduction below 50% of baseline fibrinogen levels after 2 hours from IVT. Main outcomes were (i) sICH according to National Institute of Neurological Disorders and Stroke criteria, and (ii) major bleeding.
Results:
Overall, 1678 patients were included. sICH (n=116) and major bleeding (n=297) were associated with lower prevalence of good functional recovery (p<0.001). Despite similar fibrinogen levels at admission, fibrinogen depletion after 2 hours from IVT was more common in people with sICH and major bleeding. In the backward stepwise multivariable logistic regression model, fibrinogen depletion remained a significant predictor of sICH (OR 1.55, 95%CI 1.04-2.32) and major bleeding (OR 1.36, 95%CI 1.03-1.8)
Conclusions:
Fibrinogen depletion significantly increases the risk of sICH and major bleeding after IVT for acute ischemic stroke. Routine assessment of fibrinogen might be considered to stratify the risk of ICH.
NEUROLOGICAL DISORDERS ASSOCIATED WITH COVID-19 INFECTION: AN ITALIAN MULTI-CENTER COHORT STUDY (NEURO-COVID)
- Simone Beretta (Italy)
Abstract
Background and Aims:
A variety of neurological disorders has been reported as presentations or complications of COVID-19 infection. The NEURO-COVID study is a multi-center cohort study of neurological disorders associated with COVID-19 conducted in 51 centers in Italy, sponsored by the Italian Society of Neurology (SIN).
Methods:
We present an interim analysis of hospitalized adult patients with COVID-19 infection, defined by a positive SARS-CoV-2 test independently from clinical severity, and concomitant newly diagnosed neurological disorders. Patients were recruited from March 1, 2020 to March 26, 2021 from 18 centers and followed-up prospectively for 6 months. Follow-up data at 6 months are currently ongoing and will be available for the WCN 2021 congress.
Results:
904 patients with confirmed COVID-19 infection and concomitant newly diagnosed neurological disorders were recruited. The median age was 68 years (IQR 56-78) and 57.5% were males. Severe acute respiratory syndrome occurred in 35.9%. The most common new neurological diagnoses were hypogeusia (21.1%), hyposmia (20.5%), acute ischemic stroke (19.6%), delirium (14.4%), headache (12.3%), cognitive impairment (11.3%), abnormal behaviour or psychosis (8.9%), seizures (5.9%), Guillain-Barrè syndrome (5.1%), severe encephalopathy with stupor or coma (3.7%), dizziness (3.0%), encephalitis (2.3%) and haemorrhagic stroke (2.3%). Overall, the onset of neurological disorders occurred during the presymptomatic-asymptomatic phase in 45.9%, during the acute respiratory illness in 37.5% and after recovery in 16.6%. In-hospital mortality was 12.2% and was mostly due to COVID-related respiratory failure (9.1%).
Conclusions:
A wide spectrum of treatable neurological disorders are associated with COVID-19 infection. Most cases occur in late middle-aged adults with mild or severe respiratory syndrome.