Welcome to the WSC 2022 Interactive Program

Background and Aims

The purpose was to evaluate risk factors of patients with COVID-19 pneumonia who developed acute ischemic stroke (AIS), hospitalized during the period of November 2020 - March 2021, at the COVID Center during the second wave of the pandemic.

Methods

We conducted a retrospective analysis of 566 patients with COVID-19 infection hospitalized at the center during the second wave of the pandemic. Of them, 7 who had COVID-19 pneumonia developed AIS. We analyzed demographic characteristics, stroke type, risk factors, level of D-dimer and inflammatory markers.

Results

We have analysed 2 females and 5 males with COVID-19 and AIS. Mean age was 69±13 years. All developed AIS secondary to large-vessel occlusion in the anterior circulation, in the vascular territory of middle cerebral artery (MCA). Three patients developed massive MCA ischemic stroke with hemorrhagic transformation and mass effect and had impaired level of cosciousness on admission. Mean stroke volume was 143 cm³, all had increased level of D-dimer, with mean value of 4299 mg/L (range 979-10000 mg/L).Increased values of CRP were registered in 6 patients, mean value of 72.34 mg/dL. Increased values of WBC were seen in 4 patients, mean value of 13.8. Hypertension was the most frequent risk factor, present in all 7 patients (100%). Four patients were discharged in a stable condition and 3 had lethal outcome.

Conclusions

AIS in patients with COVID-19 pneumonia is more likely to occur in elderly patients with cardiovascular comorbidities. Impaired level of consciousness, increased levels of D-dimer and CRP and COVID-19 pneumonia contribute to the patient’s fatal outcome.

Background and Aims

Background

Literature suggests that the prevalence of venous stroke in COVID-19 is less than 1%.

Objective

To study the prevalence and risk of cerebral venous sinus thrombosis (CVST) in COVID-19.

Methods

This was a cross-sectional, prospective study of 630 patients diagnosed COVID-19 who hospitalised from November, 2020 to August, 2021 in Akfa Medline Medical Center. We evaluated their clinical presentations and some laboratory data. We reviewed all cases of CVST in patients with COVID-19 infection in this period. Brain MRI done when there was severe headache or focal neurologic deficit.

Results

There were 16 patients diagnosed with CVST and COVID-19 during the study period. Patients in our case series were mostly female (9/16, 56.25%). Most patients presented with non-specific symptoms such as headache (100%) and fever (87.5%). Several patients presented with focal neurologic deficits (10/16, 62.5%) or decreased consciousness (13/16, 82.25%). D-dimer and inflammatory biomarkers were significantly elevated relative to reference ranges: D-dimers 6425.2 ng/ml, CRP 282.4 mg/l, Ferritin 1672.3 mcg/l, Fibrinogen 7.9 g/l. The superior sagittal and transverse sinuses were the most common sites for acute CVST formation (8/16, 50%). Median time to onset of focal neurologic deficit from initial COVID-19 diagnosis was 9 days (interquartile range 3–16 days). Mortality was high in this cohort (12/16 or 75%).

Conclusions

The prevalence of acute CVST in patients positive for COVID-19 is 2.54% (p<0.05) in our research. The risk of CVST in COVID-19 at least is 2.54 times higher than the literature suggests.

Background and Aims

The corononavirus 2019 (COVID-19) pandemic resulted in modifications and redistribution of resources and manpower, causing a challenge in setting up acute stroke service. We would like to share our one year experience in implementing hyperacute stroke service and our initial outcome amid this pandemic.

Methods

We retrospectively analyzed one year data from our stroke registry that began with the establishment of our hyperacute stroke service at Hospital Pengajar Universiti Putra Malaysia from April 2020 until May 2021.

Results

Setting up acute stroke services during the pandemic with constrained manpower and implementation of standard operating procedures (SOP), was a challenge. There was a significant dip during April to June 2020 due to the Movement Control Order (MCO) implemented by the government to curb COVID-19 spread. However, the numbers steadily rise approaching 2021, after the implementation of recovery MCO (Figure 1). We managed to treat 75 patients with intervention, that included intravenous thrombolysis (IVT), mechanical thrombectomy (MT) or both (Table 1). Initial outcomes in our cohort was encouraging where almost 40% of total patients who underwent hyperacute stroke treatment had early neurological recovery (ENR) and only 26% of patients had Early Neurological Deterioration (END). Mean length of hospitalization was 10 days. Despite implementing COVID-19 SOP and using magnetic resonance imaging (MRI), our door-to-imaging (DTI) and door-to-needle (DTN) time was not compromised.

Conclusions

Adaptations are necessary in times of adversity but it should not compromise the quality of acute stroke care delivered to patients.

Background and Aims

Multiple studies highlight the association between COVID-19 and stroke. We report a case series of acute ischemic stroke in COVID-19 patients without symptoms of active COVID-19 infection or risk factors for stroke with further review of the literature.

Methods

Case-1: A 51-year-old gentleman with no past medical illness developed sudden onset of right hemiparesis with slurring of speech two hours back. The PAtient was found to have a positive COVID 19 RTPCR with no respiratory symptoms.

Case-2: A 57 years old diabetic patient with a recent history of COVID 19 illness one week back, presented with sudden onset painless loss of bilateral vision with unsteadiness of gait and drowsiness for the last six hours.

Results

In both cases, an urgent MRI brain with MRA was done. Case 1 patient had acute left frontoparietal infarct with a carotid free-floating thrombus (FFT) in the left ICA. FFT is a thrombus attached to arterial wall, without complete intraluminal occlusion, particularly observed in COVID related hypercoagulative phenomena. Case 2 patient had acute infarcts in the right basal ganglia, right cerebellum and left occipital lobe, secondary to an FFT thrombus in the left vertebral artery. Both patients were thrombolysed with IVtPA, which lead to complete dissolution of the FFTs.

Conclusions

A free-floating thrombus, in the setting of a recent COVID-19 infection, and with the aetiology of both events can be attributed to a COVID-19 hypercoagulable state. Arterial FFT leading to stroke is an uncommon entity with potentially devastating effects, must be diagnosed and treated at the earliest.

Background and Aims

In SARS-CoV-2 infection, procoagulant phenomena have been described, especially in hospitalized patients. These patients have presented elevated levels of D-dimer and fibrin degradation products.Similarly, cases with other mechanisms of thrombosis have been reported, such as patients with high levels of antiphospholipid studies, and multiple cerebral infarcts as the main clinical manifestation.

Methods

A descriptive, longitudinal, retrospective study was carried out.
The iRENE database was consulted for the period March 2020 to January 2021, to collect demographic, paraclinical, and imaging information. Patients over 18 years of age, acute cerebral infarction confirmed by neuroimaging, who underwent a PCR test for SARS-CoV-2 were studied.

Results

This study showed that the epidemiological characteristics were the same between the groups with cerebral infarction and positive or negative SARS COV2 results. The etiology of cerebral infarction according to the TOAST classification was the same between the groups. In the severity of the stroke measured with the NIHSS scale, there were no differences between the groups.
Coagulation markers such as D-Dimer and Fibrinogen were found to be elevated in both groups; however, Anti B2 glycoprotein IgA was higher in patients with cerebral infarction and infection with SARS COV2 and was associated with a worse functional prognosis.

Conclusions

With these results, we propose the measurement of antiB2-glycoprotein IgA, IgM, IgG, anticardiolipins, D-dimer and fibrinogen in patients with cerebral infarction and SARS COV2 to modify therapeutic strategies during hospitalization.

Background and Aims

Administration of safe and effective vaccinations against SARS-CoV2 have been demonstrated to elicit sufficient protection and controlling this pandemic. However, there are increasing report of various type of stroke after receiving COVID-19 vaccination. Here, we present two cases of ischemic stroke after receiving COVID-19 vaccine.

Methods

We describe two cases of ischemic stroke after administration of COVID-19 vaccination and determine the likelihood cause of Adverse Drug Reaction using Naranjo Scale.

Case 1

Male, 65 years

No past medical history and previous medication

Vaccination to first symptom: 1 day, BNT162b2, First dose

Complaints & examination: Right hemiparesis

Laboratory & cardiac test: Increased D Dimer > 20x, LDL & total cholesterol

Brain imaging: Multiple lacunar infarction

Treatment: Warfarin

Outcome: Discharged with sequelae

Case 2

Male, 51 years

Past medical history: Controlled hypertension, DM, coronary artery disease

Medication: Aspirin, cardiac and DM medication

Vaccination to first symptom: 1 day, ChAdOx1, First dose

Complaints & examination: Perioral numbness and dysphagia

Laboratory & cardiac test: Increased blood glucose

Brain imaging: Multiple lacunar infarction

Treatment: Clopidogrel and cilostazol

Outcome: Discharged with sequelae

Results

The Naranjo Scale score of both cases were +3 and determined as a possible relationship between COVID-19 vaccination and occurence of stroke.

Conclusions

The emergence of persistent or unusual neurological symptoms after receiving COVID-19 vaccine should raise awareness of healthcare providers to suggest stroke associated with COVID-19 vaccines. Nevertheless, this is a rare complication that is significantly exceed by the benefit of vaccination and the risk of stroke remains higher with COVID-19 itself than with the vaccines.

Background and Aims

A 58-year-old man presented to the emergency department of Durrës Hospital with sinister inferior paresis and confusional state and dysphasia. Patient's had no, cardiovascular disease, or metabolic disease. The patient underwent a computed tomography of the head in which a low-density area was identified in the dexter frontal region (probably an ischemic area) about 3 hours after the onset of the disease.

Methods

After 6 hours, the patient presents a motor deficit in the inferior dexter side. After that, the patient undergoes an M.R.I of the head, where the hypersignal area in the bihemispheric frontal region (frontal bihemispheric infarct) was evident in T2. The patient also underwent an angio-MRI including the cervical vessels where 80% stenosis of the dexter internal carotid artery was found and in the anterior area of ​​the Circulus of Willis it was found that in the dexter anterior cerebro artery the A1 segment was dominant (hyperplastic) and in the anterior cerebro artery sinister we had hypoplasia of the A1 segment. In this case, both A1 segments (of the dexter and sinister A.C.A) are supplied with blood from the dexter Internal Carotid artery.

Results

The patient had a relatively good clinical course, with progressive improvement of motor deficit, dysphasia and cognitive functions. After 8 months, the patient underwent endarterectomy of the dexter A.C.I, which was successful. Currently in a stable condition.

Conclusions

This case reports shows a close correlation of bilateral cerebral infarction with a variation of circullus Willis also encouraged by covid 19.

Background and Aims

COVID-19 has caused unprecedented strain on the health care system across specialties. Stroke continues to be the leading cause of long-term disability across India and the world. Stroke as a complication of COVID-19 or stroke patients being vulnerable to critical complications of COVID-19, maintaining care continuum in both scenarios added unprecedented challenges to the existing strained health care system during COVID pandemic.

Methods

Retrospective chart review of stroke patients admitted from Jan 2020 to Dec 2021 at our Transition Care Centers in India.

Results

A total of 497 patients were admitted for post stroke rehabilitation during the above mentioned period. Age distribution was around 26.5% (132) < 50 years, 57.1% (284) between 50 to 75 years and 16.2% (81) >75 years. Gender distribution was around 70% (348) of males and 30% (149) of females. Amongst the admitted cases, 27.8% (139) had tracheostomy, 46.2% (230) had feeding tube, 48.2% (240) had urinary catheter and 11.4% (57) required wound care. 25.3 % (126) had hypertension and 16.4% (82) had Type 2 diabetes as pre-existing comorbidities. Almost all the patients required medical monitoring, skilled nursing care and therapy.

Conclusions

With COVID-19 adding unprecedented strain on the health care system, requirement for the quality rehabilitation to address the needs of stroke survivors continued throughout the pandemic. Requirements of stroke survivors were for long and with multiple dimensions like medical monitoring, skilled nursing and therapy. To ensure a continuum of quality and comprehensive care, there is a need for transition care centers that can provide multi-disciplinary rehabilitation at one place.

Background and Aims

On January 30, 2020, the World Health Organization (WHO) has announced the outbreak due to the novel Severe Acute Respiratory Syndrome Coronavirus 2(SARS-COV-2) and named the disease COVID-19. COVID-19 patients have presented with a wide range of neurological disorders, among which stroke is the most devastating but further studies are needed to confirm these findings. The aim of this study was to determine the association between COVID-19 and mortality for patients with stroke.

Methods

We have reviewed data from different countries on COVID-19 patients complicated with stroke by exploring current studies, case series, and case reports with a focus, and presented the current understanding of stroke in particular age population patient.

Results

Strokes in patients with COVID-19 may be due to atherosclerosis, hypertension, and atrial fibrillation, however main mechanisms that appear to be responsible for stroke and appear to be directly related to COVID-19 are hypercoagulable state, vasculitis, and cardiomyopathy. A comparison between the study cohort and control cohort study involves data of patients as per different demographic variables with a history of ischemic stroke were identified, of which study cohort patients were diagnosed with COVID-19. A control cohort without a history of ischemic stroke but diagnosed with COVID-19 was identified which showed patients with prior history of stroke (study cohort) who were older and had more comorbidities contributed to worse clinical outcomes.

Conclusions

In this review, Our findings suggest that Patients with a history of ischemic stroke, and COVID-19-associated showed several comorbid conditions contribute to worse clinical outcomes in COVID-19 patients carrying a significant risk of early mortality.

Background and Aims

Infections, including COVID-19, increase the risk of ischemic stroke. Ukraine has high mortality rates from cerebrovascular diseases (CVD). One of the indicators of the reduction of premature mortality from non-communicable diseases is the decrease in mortality from CVD aged 30-59 by sex. Aims - to identify changes in mortality from CVD for 2019-2020; assess the impact factors caused by COVID-19 pandemic, and formulate hypotheses about future changes.

Methods

The comparative analysis of mortality from cerebrovascular diseases by sex and age carried out using the information base of the study was official data of the State Statistics Service of Ukraine in 2019-2020.

Results

During the pandemic (2019-2020) there was a slight (+4.2%) increase in mortality due to cerebrovascular diseases (from 179.5 to 187.1 per 100 000). Mortality of men increased more (+6.7 %). Growth observed in all age over 50 years, most clearly (over 10% aged 80 and older). Among women, the rate increased the most at the age of 55-59 years (+10.2%).

Conclusions

The increase in mortality is due to the synergy of negative factors. These include reduced access to health care due to the concentration of efforts to combat the pandemic, the retirement of health workers infected with COVID-19, the weakening of primary / secondary prevention, and forced restrictions on mobility, especially of the elderly). Disturbances of planned long-term treatment (especially arterial hypertension) and a state of long-term chronic stress added. The increase mortality from cerebrovascular disease caused by the COVID-19 pandemic may be an obstacle to achieving the Sustainable Development Goals.

Background and Aims

During COVID-19 pandemic, hospital visiting is restricted, causing uncertainties to patients and families. We should explore solutions to deliver ASPCJ information.

Aims: To facilitate stroke patients and families in familiarization of ASPCJ; and reduce communication workload of ASU nurses.

Methods

It was a prospective study and was piloted in ASU of Pamela Youde Nethersole Eastern Hospital (PYNEH) and Ruttonjee & Tang Siu Kin Hospital (RTSKH) from April to August 2021. Randomized controlled trial was applied to recruit acute stroke patients and their families in ASU. Informative factsheets of ASPCJ were designed in hard copies (pamphlets) and soft copies (QR code card).

Questionnaires were distributed to both groups to review their feedback on stroke knowledge and satisfaction. Another questionnaire was completed by ASU nurses to review their feedback.

Results

Total 132 samples were recruited. 66 in each intervention group (IG) (QR code card or pamphlets distribution) and control group (CG) (no written information distribution). Regarding the mean stroke knowledge scores, IG showed a better result than CG, which is 7.12±1.85 and 5.3±2.37 out of 9 respectively. The mean satisfaction score about stroke service in IG is higher than that in CG, which is 4.48±0.56 and 3.55±0.79 out of 5 respectively. 66% of the samples preferred QR code cards over pamphlets.

86% of 30 ASU nurses showed positive feedback, and agreed QR code cards and pamphlets could reduce patients’ and families’ worries.

Conclusions

In conclusion, use of QR code technology to demonstrate ASPCJ can promote accessibility to obtain stroke care information under COVID-19 pandemic.

Background and Aims

COVID-19 has been a world problem since 2019. Cerebrovascular complication related to its infection have been recently revealed, and associated with its thrombosis event. When the thrombosis occurred in main branch of cerebral arteries and causing large vessel occlusion, it can lead to malignant cerebral infarct. This study showed several cases that shows relation of the COVID-19 infection and incident of malignant cerebral infarct. Cipto Mangunkusumo National Hospital is a national referred hospital for stroke cases and also COVID, with negative pressure operating theatre (OT) facility.

Methods

This is a case series, with patient data were collected through medical record and radiology data

Results

Three patients were reported with severe COVID-19 disease that run into malignant cerebral infarct. All showed hypercoagulation status. Two patients were indicated for decompressive craniectomy, and one patient treated conservatively with hyperosmolar agent to reduce the intracranial pressure. Antiviral and adjuvant treatment for COVID 19 was given concomitant with anticoagulant and antiplatelet therapy, but all of them still had poor outcome (mRS 6).

Conclusions

This study showed the pathogenesis relation of thrombosis event in malignant cerebral infarct patients caused by COVID-19 infection. COVID-19 infection can cause cytokine storm causing hypercoagulation and hyperinflammation in human bodies. Therefore, in severe COVID cases, cerebral infarct should be suspected early to prevent large occlusion leading to malignant cerebral infarct and death.

Background and Aims

Hypercoagulable state is a well-known complication of COVID-19. We aim to review the literature on cardio-cerebral infarction (CCI), a rare though severe complication of COVID-19.

Methods

Literature search was performed for case reports of simultaneous strokes and myocardial infarction (MI) with COVID-19 using various databases until April 2022 and descriptive analyses were performed.

Results

We included 12 patients presenting with CCI after suspected/confirmed COVID-19 (Males 83.3%, median 52 years) majority from the Middle East, Spain, and the US. 3 (25%) cases were positive for SARS-CoV-2 PCR, and 7 cases (58.33%) were positive for either IgG/IgM with elevated inflammatory/thrombotic markers. Ischemic stroke (75%) was the most common initial presentation: 3 moderate, 2 moderate-severe, and 2 severe strokes [NIHSS]. Type 2 DM, hypertension, and hyperlipidemia were common comorbidities. 4 cases had a same-day stroke and MI on admission. Neuroimaging demonstrated infarcts involving Left MCA (50%), Right MCA (25%), tandem occlusions (18.7%), and 1 case of multiple cortical infarcts. AIS was managed conservatively with anticoagulation+DAPT (3), IV-tPA (2), MT (1), carotid stent placement (1), and decompressive hemicraniectomy (1). CXR showed pulmonary infiltrates indicative of COVID-19 (5) and Pulmonary edema (1). Of 8 STEMI and 3 NSTEMI/UA cases, only 4 patients reported chest pain. Other complications included LV thrombus (1), pulmonary embolism (1), and ICA thrombus (1). Two patients (16.67%) died and seven (70%) had residual deficits.

Conclusions

CCI is infrequently encountered but high-risk condition with COVID-19 and has a high complication rate. More studies are needed to assess the dose/duration of thromboprophylaxis.

Background and Aims

In COVID-19 pandemic, multiple cases of Cerebral Venous Sinus Thrombosis (CVST) have been reported with the ChAdOx1 (AstraZeneca), Ad.26.COV2.S (Janssen,J&J) and later case reports of CVST with first dose of BNT162b2 (Pfizer) too, but cases of CVST after Pfizer booster have not been reported. We describe one such case of CVST after Pfizer booster.

Methods

Case

52 year old woman presented to our ER complaining of persistent gradual onset headache, started few days before presentation, initially treated with NSAIDs and antibiotics for presumed ear/sinus infection. Symptoms were persistent, pressure-like headache, with no reliving factors. Blood counts, PT/INR/PTT and metabolic panel within normal limits. MRI brain was done, which showed no stroke or parenchymal abnormality but raised concern for abnormal signal in the superior sagittal, left transverse and sigmoid sinus-concern for CVST, which was confirmed with CT-venogram. Thombophilia work up was negative.

She had received booster shot of Pfizer vaccine about 7 weeks prior to presentation and was presumed to be the cause of her CVST.

Results

Treatment and Disposition

She was treated with intravenous heparin drip in hospital for 2 days and subsequently transitioned to oral dabigatran and discharged home. Follow up brain imaging (MRV head) 3-months later showed improving recanalization of the sinus and patient was doing well and was asymptomatic.

Conclusions

Discussion: Although thrombotic side effects of COVID-19 vaccines have been reported, they have been fewer for Pfizer vaccine and to our knowledge this is the first case of CVST following temporal association with the Pfizer vaccine booster shot.

Background and Aims

March of Dimes Canada (MODC) offers a comprehensive After Stroke program focused on providing support, information, and opportunities for participation for people impacted by stroke. Prior to COVID19 pandemic outbreak most services were offered in person, whether through individual or group offerings. Responding to the COVID-19 pandemic expedited the design and delivery of online programs, and as such MODC undertook a series of projects focused on understanding the client experiences with online education offerings and determining key implementation considerations for these services.

Methods

Client and staff surveys regarding the design and delivery of virtual programs and services were conducted. In addition, focus groups and interviews were completed. An evaluation approach was developed to assess the effectiveness and efficiency of virtual program delivery

Results

Wherever possible, existing stroke support programs were pivoted to virtual platforms and modalities. Surveyed clients indicated that they preferred virtual program delivery during public health restrictions, but hybrid models may be more appropriate post pandemic response. Barriers to participation in virtual programming included access to technology, familiarity with virtual platforms, and personal communication challenges. Results of the ongoing developmental evaluation provided insights into design and delivery considerations for online programs

Conclusions

Evaluating the transition of programs and services to virtual platforms will provide health professionals, community-based organizations, and policy makers with recommendations on how to implement virtual programs for individuals impacted by stroke.

Background and Aims

Reports of COVID-19-associated acute ischemic stroke (AIS) are not uncommon, where it most likely arises in association with the prothrombotic state induced by SARS-CoV-2 infection. Due to the unique pathophysiology behind such cases of stroke, it is important to consider its implications towards management. We report a case series of three COVID-19 patients who developed AIS, with emphasis on therapeutic considerations.

Methods

We report a case series of three patients.

Results

Three male symptomatic COVID-19 patients aged 47-68 present with AIS approximately 1-7 days following onset of febrile syndromes. All patients had traditional risk factors (hypertension, diabetes mellitus, coronary artery disease) for which they are taking oral medication. All cases of AIS reported were of moderate severity (NIHSS 7-12, mRS 4 at admission), and experienced moderate to severe COVID-19 disease. Diagnostics revealed deranged inflammatory, metabolic, and coagulation markers. All patients were treated with remdesivir, clopidogrel, heparin, dexamethasone, and antibiotics, and were discharged after 8-13 days of care with clinical improvement (mRS 3).

Conclusions

We highlight that despite being infected with moderate to severe COVID-19, our patients still had favourable outcomes. Direct viral invasion, systemic inflammation (i.e., cytokine storm), endothelial dysfunction, and coagulation abnormalities contribute to the development of AIS in cases of COVID-19. Therefore in contrast to conventional AIS management, anticoagulation and glucocorticoid therapy plays an important role. Additionally, the systemic nature of COVID-19 disease also results in metabolic derangements such as renal, hepatic failure, and electrolyte imbalances, further complicating efforts in the management of stroke, as well as prognosis.

Background and Aims

The COVID-19 pandemic had affected traditional face-to-face learnings due to manpower shortage in frontline and safe management measures. Stroke patients with respiratory symptoms were also admitted to isolation wards instead of stroke unit. Isolation ward staff may not be familiar with post stroke care. Hence a stroke e-learning platform was developed to facilitate staff learning in the midst of chaos.

Methods

An e-learning platform was designed and developed, using a multi-disciplinary approach, to ensure optimal stroke care and learning opportunity were maintained. The content was developed based on healthcare professionals’ and stroke survivors’ learning needs across the stroke care continuum. This e-educational learning guide was published and shared with various stakeholders in multiple meeting platforms. The link can be easily accessible through mobile devices.

Results

The e-learning platform consists of three domains. First domain was infographics development, which was a 1-page recent evidence on stroke care for busy healthcare professionals. Second domain was short voice-annotated presentations ranging from 10 to 15 minutes on stroke care across the continuum. Third domain consists of patient education materials, which includes rehabilitation short video and fact sheets for stroke survivors and caregivers. Many positive feedbacks were received

Conclusions

This e-learning platform is useful for all healthcare professionals even in the new post-COVID normal era. There are plans to include more educational materials in the future.

Background and Aims

Coronavirus 2019 (COVID19)created a pandemic with high mortality since 2019 and it is maybe the most important global health issue of the century. Covid19 vaccines developed since autumn 2021 and had a great impact on reducing the infection rate and mortality.The point is that some complications are belonged to the vaccines.Of course most of them are very rare and the benefits are more.

Methods

A 34 years old woman who developed left hemiparesis in less than an hour after vaccine shot, referred to hospital by EMS. Brain CT scan and lab data were normal.The symptoms diminished after 3-4 hours observation and the patient discharged with diagnosis of hysterical reaction, while we kept TIA as an alternative diagnosis in mind.

A 39 years old woman who encountered right dense hemiplegia and aphasia about 12 hours after vaccination. The limb forces was about 1/5 and she was confused. The brain CT scan reveals acute ischemic stroke in MCA territory. She admitted in ICU with diagnosis of massive arterial stroke.

Results

The most important point is the history of abortion in the first case and history of DVT about one year ago,in the second patient. So both of them seem to suffer hyper coagulopathy.On the other hand both of them received inactivated virus vaccine type although thromboembolic events are more reported by adenovirus vector type vaccines.

Conclusions

The benefits of vaccination is greater than adverse effects. It should be considered that in patients with history of hyper coagulopathic disorders vaccines should be prescribed with more caution.

Background and Aims

The first COVID case was reported in early March 2020; after which all patients admitted to our general state hospital were screened for COVID-19. The aim of our study is to examine the trends in hospitalisation for stroke patients amongst the Maltese population during the pandemic. Different characteristics were also looked into and compared to the 2 years preceding the pandemic.

Methods

Our study was a retrospective study. All patients admitted to our state hospital with a diagnosis of an acute ischemic stroke were included. Data gathered included patient demographics, length of stay, baseline NIHSS, discharge destination and mortality. Data was gathered from patients admitted between March 2018-February 2020; and between March 2020-February 2022.

Results

During the pre-COVID era, a total number of 1044 patients were admitted with an acute ischemic stroke. The majority of patients were male (M=51.5%), with a median age of 74 years(SD+/-13.8). The average length of in-hospital stay was 11.4 days(SD+/-18.7). 16% or our patients died during their admission, 18% were discharged to a rehab facility and 56% were discharged home.

During the COVID years,909 patients were admitted;(M=53.5%); median age of 73.1 years(SD+/-13.7). The average length of stay was 11.6 days(SD +/-15.4). 17% of patients passed away, 10% discharged to a rehab facility, 61% were discharged home.

Conclusions

In line with different international population studies, Malta has seen a decrease in the number of stroke admissions during the pandemic, with non-significant differences in the patients' demographics. Less patients received rehabilitation and more patients were discharged home.

Background and Aims

By literature review there is no consensus on anticoagulant therapy for CVST prevention among patients with COVID-19

Purpose of the study:

To determine more safe and effective anticoagulant in venous stroke prevention among patients with severe COVID19.

Methods

Totally 630 patients participated in the study. All patients got treatment based on national COVID19 guideline at the Akfa Medline MC in the period of November, 2020 up to August, 2021. Criteria for severe COVID19 were following: SpO2 <92% on roomair, PaO2/FiO2<300 mmHg, respiratory frequency >30 breaths perminute, lung infiltrates >50% on CT. Eight patients died till to recheck time. 3 patients didn’t manage to come for recheck. Therefore, finally 509 patients are included in the study and divided into three groups. First group of patients got Heparin in dosage 24000 –36000 IU per day. Second group took Enoxaparin 1mg/kgBM/day. Third group - Rivaroxaban 20 mg per day. Follow up done on 2nd-3rd-4th-5th-6th week after start of treatment. Brain MRI done when there was severe headache or focal neurologic deficit.

Results

All groups of patients had comparable demographic data.

Conclusions

Cerebral Venous Sinuses thrombosis prevalence is significantly higher in patients getting Heparin (p≤0,05). Enoxaparine and Rivaroxabane showed their safety and effectiveness in venous stroke prevention in severe COVID19.