Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. Summary: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages: Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.

1.
World Health Organization
.
Coronavirus disease (COVID-19) weekly epidemiological update
. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports Accessed 2020 Nov 25.
2.
Powers
WJ
,
Rabinstein
AA
,
Ackerson
T
,
Adeoye
OM
,
Bambakidis
NC
,
Becker
K
,
.
Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association
.
Stroke
.
2019
;
50
(
12
):
e344
418
.
3.
Wuhan-Hu-1 (Wuhan seafood market pneumonia virus isolate) complete genome
.
Bethesda, MD
;
Nucleotide, National Library of Medicine (United States), National Center for Biotechnology Information
. Available from: https://www.ncbi.nlm.nih.gov/nuccore/1798174254.
4.
Huang
C
,
Wang
Y
,
Li
X
,
Ren
L
,
Zhao
J
,
Hu
Y
,
.
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
.
Lancet
.
2020
;
395
(
10223
):
497
506
.
5.
Li
X
,
Geng
M
,
Peng
Y
,
Meng
L
,
Lu
S
.
Molecular immune pathogenesis and diagnosis of COVID-19
.
J Pharm Anal
.
2020
;
10
(
2
):
102
8
.
6.
Su
S
,
Wong
G
,
Shi
W
,
Liu
J
,
Lai
AC
,
Zhou
J
,
.
Epidemiology, genetic recombination, and pathogenesis of coronaviruses
.
Trends Microbiol
.
2016
;
24
(
6
):
490
502
.
7.
Li
W
,
Moore
MJ
,
Vasilieva
N
,
Sui
J
,
Wong
SK
,
Berne
MA
,
.
Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus
.
Nature
.
2003
;
426
(
6965
):
450
4
.
8.
Wu
F
,
Zhao
S
,
Yu
B
,
Chen
YM
,
Wang
W
,
Song
ZG
,
.
A new coronavirus associated with human respiratory disease in China
.
Nature
.
2020
;
579
(
7798
):
265
9
.
9.
Wrapp
D
,
Wang
N
,
Corbett
KS
,
Goldsmith
JA
,
Hsieh
CL
,
Abiona
O
,
.
Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation
.
Science
.
2020
;
367
(
6483
):
1260
3
.
10.
Schaller
T
,
Hirschbühl
K
,
Burkhardt
K
,
Braun
G
,
Trepel
M
,
Märkl
B
,
.
Postmortem examination of patients with COVID-19
.
JAMA
.
2020
;
323
(
24
):
2518
20
.
11.
Venketasubramanian
N
,
Hennerici
MG
.
Stroke in COVID-19 and SARS-CoV-1
.
Cerebrovasc Dis
.
2020
;
49
(
3
):
235
6
.
12.
Varga
Z
,
Flammer
AJ
,
Steiger
P
,
Haberecker
M
,
Andermatt
R
,
Zinkernagel
AS
,
.
Endothelial cell infection and endotheliitis in COVID-19
.
Lancet
.
2020
;
395
(
10234
):
1417
8
.
13.
Clerkin
KJ
,
Fried
JA
,
Raikhelkar
J
,
Sayer
G
,
Griffin
JM
,
Masoumi
A
,
.
COVID-19 and cardiovascular disease
.
Circulation
.
2020
;
141
(
20
):
1648
55
.
14.
Madjid
M
,
Safavi-Naeini
P
,
Solomon
SD
,
Vardeny
O
.
Potential effects of coronaviruses on the cardiovascular system: a review
.
JAMA Cardiol
.
2020 Jul 1
;
5
(
7
):
831
40
.
15.
Ye
Q
,
Wang
B
,
Mao
J
.
The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19
.
J Infect
.
2020
;
80
(
6
):
607
13
.
16.
Bikdeli
B
,
Madhavan
MV
,
Jimenez
D
,
Chuich
T
,
Dreyfus
I
,
Driggin
E
,
.
COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up
.
J Am Coll Cardiol
.
2020
;
75
:
2950
73
.
17.
Zhang
Y
,
Xiao
M
,
Zhang
S
,
Xia
P
,
Cao
W
,
Jiang
W
,
.
Coagulopathy and antiphospholipid antibodies in patients with covid-19
.
N Engl J Med
.
2020
;
382
(
17
):
e38
.
18.
Steckelings
UM
,
Sumners
C
.
Correcting the imbalanced protective RAS in COVID-19 with angiotensin AT2-receptor agonists
.
Clin Sci
.
2020
;
134
(
22
):
2987
3006
.
19.
Janardhan
V
,
Janardhan
V
,
Kalousek
V
.
COVID-19 as a blood clotting disorder masquerading as a respiratory illness: a cerebrovascular perspective and therapeutic implications for stroke thrombectomy
.
J Neuroimaging
.
2020
;
30
(
5
):
555
61
.
20.
Najjar
S
,
Najjar
A
,
Chong
DJ
,
Pramanik
BK
,
Kirsch
C
,
Kuzniecky
RI
,
.
Central nervous system complications associated with SARS-CoV-2 infection: integrative concepts of pathophysiology and case reports
.
J Neuroinflammation
.
2020
;
17
(
1
):
231
.
21.
Bhatraju
PK
,
Ghassemieh
BJ
,
Nichols
M
,
Kim
R
,
Jerome
KR
,
Nalla
AK
,
.
Covid-19 in critically ill patients in the Seattle region: case series
.
N Engl J Med
.
2020
;
382
(
21
):
2012
22
.
22.
Markus
HS
,
Brainin
M
.
COVID-19 and stroke-A global World Stroke Organization perspective
.
Int J Stroke
.
2020
;
15
(
4
):
361
4
.
23.
Brainin
M
.
Stroke care and the COVID19 pandemic words from our President
. Available from: www.world-stroke.org/news-andblog/news/stroke-care-and-the-covid19-pandemic Accessed 2020 Apr 11.
24.
Qureshi
AI
,
Abd-Allah
F
,
Al-Senani
F
,
Aytac
E
,
Borhani-Haghighi
A
,
Ciccone
A
,
.
Management of acute ischemic stroke in patients with COVID-19 infection: report of an international panel
.
Int J Stroke
.
2020
;
15
(
5
):
540
54
.
25.
Chiu
IM
,
Cheng
CY
,
Zhang
H
,
Lin
CR
.
Self-screening to reduce medical resource consumption facing the COVID-19 pandemic
.
Emerg Med J
.
2020
;
37
(
5
):
255
.
26.
Gostic
K
,
Gomez
AC
,
Mummah
RO
,
Kucharski
AJ
,
Lloyd-Smith
JO
.
Estimated effectiveness of symptom and risk screening to prevent the spread of COVID-19
.
Elife
.
2020
;
9
:
e55570
.
27.
Walter
S
,
Kostopoulos
P
,
Haass
A
,
Keller
I
,
Lesmeister
M
,
Schlechtriemen
T
,
.
Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial
.
Lancet Neurol
.
2012
;
11
:
397
404
.
28.
Yang
WS
,
Hou
SW
,
Lee
BC
,
Chiang
WC
,
Chien
YC
,
Chen
SY
,
.
Taipei Azalea: supraglottic airways (SGA) preassembled with high-efficiency particulate air (HEPA) filters to simplify prehospital airway management for patients with out-of-hospital cardiac arrests (OHCA) during coronavirus disease 2019 (COVID-19) pandemic
.
Resuscitation
.
2020
;
151
:
3
5
.
29.
AHA/ASA Stroke Council Leadership
.
Temporary emergency guidance to US stroke centers during the coronavirus disease 2019 (COVID-19) pandemic: American Heart Association/American Stroke Association Stroke Council Leadership
.
Stroke
.
2020
;
51
:
1896
901
.
30.
Khosravani
H
,
MDP Rajendram
P
,
Notario
L
,
Chapman
MG
,
Menon
BK
.
Protected code stroke. hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic
.
Stroke
.
2020
;
51
:
1891
5
.
31.
Leira
EC
,
Russman
AN
,
Biller
J
,
Brown
DL
,
Bushnell
CD
,
Caso
V
,
.
Preserving stroke care during the COVID-19 pandemic: potential issues and solutions
.
Neurology
.
2020
;
95
(
3
):
124
33
.
32.
World Health Organization
.
Antigen-detection in the diagnosis of SARS-CoV-2 infection using rapid immunoassays. Interim guidance
. Updated 2020 Sep 11. Available from: https://www.who.int/publications/i/item/antigen-detection-in-the-diagnosis-of-sars-cov-2infection-using-rapid-immunoassays.
33.
Meyer
D
,
Meyer
BC
,
Rapp
KS
,
Modir
R
,
Agrawal
K
,
Hailey
L
,
.
A stroke care model at an academic, comprehensive stroke center during the 2020 COVID-19 pandemic
.
J Stroke Cerebrovasc Dis
.
2020
;
29
(
8
):
104927
.
34.
Goyal
M
,
Ospel
JM
,
Southerland
AM
,
Wira
C
,
Amin-Hanjani
S
,
Fraser
JF
,
.
Prehospital triage of acute stroke patients during the COVID-19 pandemic
.
Stroke
.
2020
;
51
:
2263
7
.
35.
Baracchini
C
,
Pieroni
A
,
Viaro
F
,
Cianci
V
,
Cattelan
AM
,
Tiberio
I
,
.
Acute stroke management pathway during coronavirus-19 pandemic
.
Neurol Sci
.
2020
;
41
(
5
):
1003
5
.
36.
Nguyen
TN
,
MD
,
Abdalkader
M
,
Jovin
TG
,
Nogueira
RG
,
Jadhav
AP
,
.
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
.
Stroke
.
2020
;
51
:
1896
901
.
37.
Smith
MS
,
Bonomo
J
,
Knight
IVWA
,
Prestigiacomo
CJ
,
Richards
CT
,
Ramser
E
,
.
Endovascular therapy for patients with acute ischemic stroke during the COVID-19 pandemic. A proposed algorithm
.
Stroke
.
2020
;
51
:
1902
9
.
38.
Larson
AS
,
Savastano
L
,
Kadirvel
R
,
Kallmes
DF
,
Hassan
AE
,
Brinjikji
W
.
Coronavirus disease 2019 and the cerebrovascular-cardiovascular systems: what do we know so far
.
J Am Heart Assoc
.
2020
;
9
(
13
):
e016793
.
39.
Urbach
H
,
Janssen
H
,
Linn
J
,
Hoffmann
T
,
Tritt
S
,
Weber
W
,
.
Acute neurointerventions, covid-19 and chest-CT: SOP and literature review
.
Clin Neuroradiol
.
2020 Sep
;
30
(
3
):
447
52
.
40.
Kwee
RM
,
Krdzalic
J
,
Fasen
BACM
,
de Jaegere
TMH
;
COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group
.
CT scanning in suspected stroke or head trauma: is it worth going the extra mile and including the chest to screen for COVID-19 infection
.
AJNR Am J Neuroradiol
.
2020
;
41
:
1165
9
.
41.
Baracchini
C
,
Pieroni
A
,
Kneihsl
M
,
Azevedo
E
,
Diomedi
M
,
Pascazio
L
,
.
Practice recommendations for the neurovascular ultrasound investigations of acute stroke patients in the setting of COVID-19 pandemic: an expert consensus from the European Society of Neurosonology and Cerebral Hemodynamics
.
Eur J Neurol
.
2020 Sep
;
27
:
1776
80
.
42.
Thomalla
G
,
Simonsen
CZ
,
Boutitie
F
,
Andersen
G
,
Berthezene
Y
,
Cheng
B
,
.
MRI-guided thrombolysis for stroke with unknown time of onset
.
N Engl J Med
.
2018
;
379
:
611
22
.
43.
Ma
H
,
Campbell
BCV
,
Parsons
MW
,
Churilov
L
,
Levi
CR
,
Hsu
C
,
.
Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke
.
N Engl J Med
.
2019
;
380
:
1795
803
.
44.
Koga
M
,
Yamamoto
H
,
Inoue
M
,
Asakura
K
,
Aoki
J
,
Hamasaki
T
,
.
THAWS Trial Investigators. Thrombolysis with alteplase at 0.6 mg/kg for stroke with unknown time of onset: a randomized controlled trial
.
Stroke
.
2020
;
51
:
1530
8
.
45.
Helms
J
,
Tacquard
C
,
Severac
F
,
Leonard-Lorant
I
,
Ohana
M
,
Delabranche
X
,
.
High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
.
Intensive Care Med
.
2020
;
46
:
1089
98
.
46.
Klok
FA
,
Kruip
MJHA
,
van der Meer
NJM
,
Arbous
MS
,
Gommers
D
,
Kant
KM
,
.
Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis
.
Thromb Res
.
2020
;
191
:
148
50
.
47.
Oxley
TJ
,
Mocco
J
,
Majidi
S
,
Kellner
CP
,
Shoirah
H
,
Singh
IP
,
.
Large-vessel stroke as a presenting feature of Covid-19 in the young
.
N Engl J Med
.
2020
;
382
(
20
):
e60
.
48.
Montaner
J
,
Barragán-Prieto
A
,
Pérez-Sánchez
S
,
Escudero-Martínez
I
,
Moniche
F
,
Sánchez-Miura
JA
,
.
Break in the stroke chain of survival due to COVID-19
.
Stroke
.
2020
;
51
(
8
):
2307
14
.
49.
Neves Briard
J
,
Ducroux
C
,
Jacquin
G
,
Alesefir
W
,
Boisseau
W
,
Daneault
N
,
.
Early impact of the COVID-19 pandemic on acute stroke treatment delays
.
Can J Neurol Sci
.
2021 Jan
;
48
(
1
):
122
6
.
50.
Katsanos
AH
,
de Sa Boasquevisque
D
,
Al-Qarni
MA
,
Shawawrah
M
,
McNicoll-Whiteman
R
,
Gould
L
,
.
In-hospital delays for acute stroke treatment delivery during the COVID-19 pandemic
.
Can J Neurol Sci
.
2021 Jan
;
48
(
1
):
59
65
.
51.
Uchino
K
,
Kolikonda
MK
,
Brown
D
,
Kovi
S
,
Collins
D
,
Khawaja
Z
,
.
Decline in stroke presentations during COVID-19 surge
.
Stroke
.
2020
;
51
(
8
):
2544
7
.
52.
Jasne
AS
,
Chojecka
P
,
Maran
I
,
Mageid
R
,
Eldokmak
M
,
Zhang
Q
,
.
Stroke code presentations, interventions, and outcomes before and during the COVID-19 pandemic
.
Stroke
.
2020
;
51
(
9
):
2664
73
.
53.
Selby
NM
,
Forni
LG
,
Laing
CM
,
Horne
KL
,
Evans
RD
,
Lucas
BJ
,
.
Covid-19 and acute kidney injury in hospital: summary of NICE guidelines
.
BMJ
.
2020
;
369
:
m1963
.
54.
Lyden
P
.
Temporary emergency guidance to US stroke centers during the COVID-19 pandemic on behalf of the AHA/ASA Stroke Council Leadership
.
Stroke
.
2020
;
51
:
1910
2
.
55.
Agarwal
S
,
Scher
E
,
Rossan-Raghunath
N
,
Marolia
D
,
Butnar
M
,
Torres
J
,
.
Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic
.
J Stroke Cerebrovasc Dis
.
2020
;
29
(
9
):
105068
.
56.
Frisullo
G
,
Brunetti
V
,
Di Iorio
R
,
Broccolini
A
,
Caliandro
P
,
Monforte
M
,
.
Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital
.
Neurol Sci
.
2020
;
41
(
9
):
2309
13
.
57.
Plumereau
C
,
Cho
TH
,
Buisson
M
,
Amaz
C
,
Cappucci
M
,
Derex
L
,
.
Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network
.
J Neurol
.
2020 Sep 9
:
1
6
. Epub ahead of print.http://dx.doi.org/10.1007/s00415-020-10199-6.
58.
John
S
,
Hussain
SI
,
Piechowski-Jozwiak
B
,
Dibu
J
,
Kesav
P
,
Bayrlee
A
,
.
Clinical characteristics and admission patterns of stroke patients during the COVID 19 pandemic: a single center retrospective, observational study from the Abu Dhabi, United Arab Emirates
.
Clin Neurol Neurosurg
.
2020
;
199
:
106227
.
59.
Tiwari
A
,
Berekashvili
K
,
Vulkanov
V
,
Agarwal
S
,
Khaneja
A
,
Turkel-Parella
D
,
.
Etiologic subtypes of ischemic stroke in SARS-CoV-2 patients in a cohort of New York City Hospitals
.
Front Neurol
.
2020
;
11
:
1004
.
60.
Wang
A
,
Mandigo
GK
,
Yim
PD
,
Meyers
PM
,
Lavine
SD
.
Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics
.
J Neurointerv Surg
.
2020
;
12
(
7
):
648
53
.
61.
Al Saiegh
F
,
Ghosh
R
,
Leibold
A
,
Avery
MB
,
Schmidt
RF
,
Theofanis
T
,
.
Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke
.
J Neurol Neurosurg Psychiatry
.
2020
;
91
(
8
):
846
8
.
62.
Escalard
S
,
Maier
B
,
Redjem
H
,
Delvoye
F
,
Hébert
S
,
Smajda
S
,
.
Treatment of acute ischemic stroke due to large vessel occlusion with COVID-19
.
Stroke
.
2020
;
51
:
2540
3
.
63.
Bach
I
,
Surathi
P
,
Montealegre
N
,
Abu-Hadid
O
,
Rubenstein
S
,
Redko
S
,
.
Stroke in COVID-19: a single-centre initial experience in a hotspot of the pandemic
.
Stroke Vasc Neurol
.
2020 Dec
;
5
:
331
6
.
64.
Rubin
M
,
Bonnie
RJ
,
Epstein
L
,
Hemphill
C
,
Kirschen
M
,
Lewis
A
,
.
AAN Position Statement: the COVID-19 pandemic and the ethical duties of the neurologist
.
Neurology
.
2020
;
95
:
167
72
.
65.
Survey among German neurointensivists at academic hospitals in March 2020 (under consideration for publication)
.
66.
Alhazzi
W
,
Moeller
MH
,
Arabi
YM
,
Loeb
M
,
Gong
MN
,
Fan
E
,
.
Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19)
.
Crit Care Med
.
2020
;
46
:
854
87
.
67.
Canelli
R
,
Connor
CW
,
Gonzalez
M
,
Nozari
A
,
Ortega
R
.
Barrier enclosure during endotracheal intubation
.
N Engl J Med
.
2020
;
382
(
20
):
1957
8
.
68.
Brigham and Women’s Hospital COVID-19 clinical guidelines
.
2020
. Available from: https://covidprotocols.org/.
69.
Addendum to Emory Healthcare’s Brain Death Determination Policy effective
.
2020 Apr 17
. Available from: https://www.emoryhealthcare.org/ui/pdfs/covid/medical-professionals/Brain Death Testing in the Setting of COVID-19.pdf.
70.
Li
Y
,
Li
M
,
Wang
M
,
Zhou
Y
,
Chang
J
,
Xian
Y
,
.
Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study
.
Stroke Vasc Neurol
.
2020 Sep
;
5
(
3
):
279
84
.
71.
He
Q
,
Wu
C
,
Luo
H
,
Wang
ZY
,
Ma
XQ
,
Zhao
YF
,
.
Trends in in-hospital mortality among patients with stroke in China
.
PLoS One
.
2014
;
9
(
3
):
e92763
.
72.
Moreno
R
,
Vincent
JL
,
Matos
R
,
Mendonça
A
,
Cantraine
F
,
Thijs
L
,
.
The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicenter study. Working group on sepsis related problems of the ESICM
.
Intensive Care Med
.
1999
;
25
:
686
96
.
73.
Guan
WJ
,
Ni
ZY
,
Hu
Y
,
Liang
WH
,
Ou
CQ
,
He
JX
,
.
Clinical characteristics of coronavirus disease 2019 in China
.
N Engl J Med
.
2020
;
382
:
1708
20
.
74.
Warren-Gash
C
,
Blackburn
R
,
Whitaker
H
,
McMenamin
J
,
Hayward
AC
.
Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland
.
Eur Respir J
.
2018
;
51
(
3
):
1701794
.
75.
Zunt
J
.
Invited commentary: neurology during the COVID-19 pandemic: lessons learned at the initial U.S. epicenter
.
Neurology
.
2020
. Available from: blogs.neurology.org Accessed 2020 Apr 10.
76.
Mao
L
,
Jin
H
,
Wang
M
,
Hu
Y
,
Chen
S
,
He
Q
,
.
Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study
.
JAMA Neurol
.
2020
;
77
:
1
9
.
77.
Beyrouti
R
,
Adams
ME
,
Benjamin
L
,
Cohen
H
,
Farmer
SF
,
Goh
YY
,
.
Characteristics of ischaemic stroke associated with COVID-19
.
J Neurol Neurosurg Psychiatry
.
2020
;
91
(
8
):
889
91
.
78.
Zhai
Z
,
Li
C
,
Chen
Y
,
Gerotziafas
G
,
Zhang
Z
,
Wan
J
,
.
Prevention and treatment of venous thromboembolism associated with coronavirus disease 2019 infection: a consensus statement before guidelines
.
Thromb Haemost
.
2020
;
120
(
6
):
937
48
.
79.
Hess
DC
,
Eldahshan
W
,
Rutkowski
E
.
COVID-19-related stroke
.
Transl Stroke Res
.
2020
;
11
(
3
):
322
5
.
80.
Avula
A
,
Nalleballe
K
,
Narula
N
,
Sapozhnikov
S
,
Dandu
V
,
Toom
S
,
.
COVID-19 presenting as stroke
.
Brain Behav Immun
.
2020
;
87
:
115
9
.
81.
Zhou
F
,
Yu
T
,
Du
R
,
Fan
G
,
Liu
Y
,
Liu
Z
,
.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
.
Lancet
.
2020
;
395
(
10229
):
1054
62
.
82.
Muhammad
S
,
Petridis
A
,
Cornelius
JF
,
Hanggi
D
.
Letter to editor: severe brain haemorrhage and concomitant COVID-19 infection: a neurovascular complication of COVID-19
.
Brain Behav Immun
.
2020
;
87
:
150
1
.
83.
Garaci
F
,
Di Giuliano
F
,
Picchi
E
,
Da RosFloris
VR
,
Floris
R
.
Venous cerebral thrombosis in COVID-19 patient
.
J Neurol Sci
.
2020
;
414
:
116871
.
84.
Aggarwal
G
,
Lippi
G
,
Michael Henry
B
.
Cerebrovascular disease is associated with an increased disease severity in patients with coronavirus disease 2019 (COVID-19): a pooled analysis of published literature
.
Int J Stroke
.
2020
;
15
(
4
):
385
9
.
85.
Mancia
G
,
Rea
F
,
Ludergnani
M
,
Apolone
G
,
Corrao
G
.
Renin-angiotensin-aldosterone system blockers and the risk of covid-19
.
N Engl J Med
.
2020
;
382
(
25
):
2431
40
.
86.
Li
J
,
Wang
X
,
Chen
J
,
Zhang
H
,
Deng
A
.
Association of renin-angiotensin system inhibitors with severity of risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China
.
JAMA Cardiol
.
2020
;
5
:
1
6
.
87.
Recommendations on treatment of COVID-19
. COVID-19 Information Hub by American Association of Neurological Surgeons (Revised 2020 May 27).
88.
He
Y
,
Hong
T
,
Wang
M
,
Jiao
L
,
Ge
Y
,
Haacke
EM
,
.
Prevention and control of COVID-19 in neurointerventional surgery: expert consensus from the Chinese Federation of Interventional and Therapeutic Neuroradiology (CFITN) and the International Society for Neurovascular Disease (ISNVD)
.
J Neurointerv Surg
.
2020
;
12
(
7
):
658
63
.
89.
American Association of Neurological Surgeons (AANS)
.
COVID-19 and neurosurgery
. Available from: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and- Treatments/COVID-19-and-Neurosurgery.
90.
Powers
WJ
,
Rabinstein
AA
,
Ackerson
T
,
Adeoye
OM
,
Bambakidis
NC
,
Becker
K
,
.
2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association
.
Stroke
.
2018
;
49
:
e46
110
.
91.
Mehta
N
,
Kalra
A
,
Nowacki
AS
,
Anjewierden
S
,
Han
Z
,
Bhat
P
,
.
Association of use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (COVID-19)
.
JAMA Cardiol
.
2020 May 5
;
5
(
9
):
1020
.
92.
Reynolds
HR
,
Adhikari
S
,
Pulgarin
C
,
Troxel
AB
,
Iturrate
E
,
Johnson
SB
,
.
Renin-angiotensin-aldosterone system inhibitors and risk of covid-19
.
N Engl J Med
.
2020
;
382
(
25
):
2441
8
.
93.
Zhang
P
,
Zhu
L
,
Cai
J
,
Lei
F
,
Qin
JJ
,
Xie
J
,
.
Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19
.
Circ Res
.
2020
;
126
(
12
):
1671
81
.
94.
Violi
F
,
Pastori
D
,
Cangemi
R
,
Pignatelli
P
,
Loffredo
L
.
Hypercoagulation and antithrombotic treatment in coronavirus 2019: a new challenge
.
Thromb Haemost
.
2020
;
120
(
6
):
949
56
.
95.
Thachil
J
,
Tang
N
,
Gando
S
,
Falanga
A
,
Cattaneo
M
,
Levi
M
,
.
ISTH interim guidance on recognition and management of coagulopathy in COVID-19
.
J Thromb Haemost
.
2020
;
18
(
5
):
1023
6
.
96.
Paranjpe
I
,
Fuster
V
,
Lala
A
,
Russak
AJ
,
Glicksberg
BS
,
Levin
MA
,
.
Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19
.
J Am Coll Cardiol
.
2020
;
76
(
1
):
122
4
.
97.
Tang
N
,
Bai
H
,
Chen
X
,
Gong
J
,
Li
D
,
Sun
Z
.
Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy
.
J Thromb Haemost
.
2020
;
18
:
1094
9
.
98.
Albani
F
,
Sepe
L
,
Fusina
F
,
Prezioso
C
,
Baronio
M
,
Caminiti
F
,
.
Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study
.
EClinicalMedicine
.
2020 Oct 5
;
27
:
100562
.
99.
Stroke rehabilitation: therapy. NICE Guidelines
. Last updated 2020 Apr 16. Available from: http://pathways.nice.org.uk/pathways/stroke NICE Pathway.
100.
Shaw
RC
,
Walker
G
,
Elliott
E
,
Quinn
TJ
.
Occurrence rate of delirium in acute stroke settings: systematic review and meta-analysis
.
Stroke
.
2019
;
50
(
11
):
3028
36
.
101.
Epstein
D
,
Andrawis
W
,
Lipsky
AM
,
Ziad
HA
,
Matan
M
,
Epstein
D
.
Anxiety and suicidality in a hospitalized patient with COVID-19 infection
.
Eur J Case Rep Intern Med
.
2020
;
7
(
5
):
001651
.
102.
Shore
JH
.
Telepsychiatry: videoconferencing in the delivery of psychiatric care
.
Am J Psychiatry
.
2017
;
170
(
3
):
256
62
.
103.
American Psychiatric Association and American Telemedicine Association
.
Best practices in videoconferencing-based telemental health
.
2018 Apr
. Available from: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Telepsychiatry/APA-ATA-Best-Practices-in-Videoconferencing-Based-Telemental-Health.pdf.
104.
Ho
CS
,
Chee
CY
,
Ho
RC
.
Mental health strategies to combat the psychological impact of COVID-19: beyond paranoia and panic
.
Ann Acad Med Singapore
.
2020
;
49
:
1
3
.
105.
Leppert
MH
,
Sillau
S
,
Lindrooth
RC
,
Poisson
SN
,
Campbell
JD
,
Simpson
JR
.
Relationship between early follow-up and readmission within 30 and 90 days after ischemic stroke
.
Neurology
.
2020
;
94
(
12
):
e1249
58
.
106.
Kilkenny
MF
,
Longworth
M
,
Pollack
M
,
Levi
C
,
Cadilhac
DA
.
Factors associated with 28-day hospital readmission after stroke in Australia
.
Stroke
.
2013
;
44
(
8
):
2260
8
.
107.
Park
JH
,
Ovbiagele
B
.
Optimal combination secondary prevention drug treatment and stroke outcomes
.
Neurology
.
2015
;
84
(
1
):
50
6
.
108.
Bushnell
CD
,
Olson
DM
,
Zhao
X
,
Pan
W
,
Zimmer
LO
,
Goldstein
LB
,
.
Secondary preventive medication persistence and adherence 1 year after stroke
.
Neurology
.
2011
;
77
(
12
):
1182
90
.
109.
Winstein
CJ
,
Stein
J
,
Arena
R
,
Bates
B
,
Cherney
LR
,
Cramer
SC
,
.
Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association
.
Stroke
.
2016
;
47
(
6
):
e98
169
.
110.
Zhang
Y
,
Xiao
M
,
Zhang
S
,
Xia
P
,
Cao
W
,
Jiang
W
,
.
Coagulopathy and antiphospholipid antibodies in patients with Covid-19
.
N Engl J Med
.
2020
;
382
(
17
):
e38
.
111.
Pendlebury
ST
,
Rothwell
PM
.
Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis
.
Lancet Neurol
.
2009
;
8
(
11
):
1006
18
.
112.
Creasy
KR
,
Lutz
BJ
,
Young
ME
,
Stacciarini
JM
.
Clinical implications of family-centered care in stroke rehabilitation
.
Rehabil Nurs
.
2015
;
40
(
6
):
349
.
113.
Dafer
RM
,
Osteraas
ND
,
Biller
J
.
Acute stroke care in the coronavirus disease 2019 pandemic
.
J Stroke Cerebrovasc Dis
.
2020
;
29
(
7
):
104881
.
114.
ESC guidance for the diagnosis and management of CV disease during the COVID-19 pandemic
.
2020
. Available from: https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance Accessed 2020 May 28.
115.
Ren’eeShellhaas
ARA
.
Neurologists and COVID-19. A note on courage in a time of uncertainty
.
Neurology
.
2020
;
94
:
855
7
.
116.
Bauchner
H
,
Sharfstein
J
.
A bold response to the COVID-19 pandemic: medical students, national service, and public health
.
JAMA
.
2020
;
323
:
1790
1
.
117.
Kim
JS
.
Coronavirus disease 2019 and stroke
.
J Stroke
.
2020
;
22
(
2
):
157
8
.
118.
Roushdy
TM
,
Nahas
NME
,
Aref
HM
,
Georgy
SS
,
Zaki
AS
,
Bedros
RY
,
.
Stroke in the time of coronavirus disease 2019: experience of two university stroke centers in Egypt
.
J Stroke
.
2020
;
22
(
2
):
275
7
.
119.
Kardas-Nelson
M
.
Covid-19’s impact on US medical research-shifting money, easing rules
.
BMJ
.
2020
;
369
:
m1744
.
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