New Guidelines for Stroke Care During the COVID-19 Pandemic
BLOOD clotting increases have been observed in patients with COVID-19, which raises their risk of conditions such as stroke. Based on international research on the link between stroke and COVID-19, a team of stroke experts developed recommendations for the evaluation of patients with acute ischaemic stroke with suspected or confirmed COVID-19 infection.
The international panel comprised stroke experts from 18 countries with documented COVID-19 outbreaks and was led by Prof Adnan I. Qureshi, University of Missouri School of Medicine, Columbia, Missouri, USA. Evidence found by the research team showed that ischaemic stroke with clots in the arteries of the brain are being experienced by young people who do not have previous risk factors for stroke; this is thought to be related to the patient having a COVID-19 infection. The average onset of stroke in patients with COVID-19 occurred on Day 10 of infection; however, in some cases stroke was the initial symptom of a COVID-19 infection.
Prof Qureshi’s research indicates that healthcare workers attending to patients with stroke may be at risk of becoming infected with COVID-19, recommending that safety precautions should be taken, including that the number of care providers who have direct interaction with each patient should be limited. Furthermore, providers should treat patients with stroke and suspected COVID-19 as though they have the infection and ensure that all equipment used during the stroke assessment is sufficiently sanitised.
Rapid evidence of COVID-19 infection in a patient can be obtained from a chest CT, of which should be performed in patients with stroke suspected of having COVID-19, the guidelines suggest. A simultaneous chest and brain CT can be used in patients presenting to the emergency department to identify any evidence in the lungs of COVID-19 while examining signs of stroke in the brain, a step that has been incorporated into the acute stroke protocol at University of Missouri Health Care. In cases of a confirmed COVID-19 infection and the involvement of other organs, the guidelines suggest that an overall prognosis can be determined by a sequential organ failure assessment (SOFA), to aid in the decision of an appropriate stroke treatment.
“The purpose of these recommendations is to provide a step-by-step guide of how to manage these patients. The modifications we suggest have implications for the health of patients, but also the health of those who are involved in their care,” Prof Qureshi commented.