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BACKGROUND AND PURPOSE: The experience gained during the first COVID-19 wave could have mitigated the negative impact on stroke care in the following waves. Our aims were to analyze the characteristics and outcomes of patients with stroke admitted during the second COVID-19 wave and to evaluate the differences in the stroke care provision compared with the first wave. METHODS: This retrospective multicenter cohort study included consecutive stroke patients admitted to any of the seven hospitals with stroke units (SUs) and endovascular treatment facilities in the Madrid Health Region. The characteristics of the stroke patients with or without a COVID-19 diagnosis were compared and the organizational changes in stroke care between the first wave (25 February to 25 April 2020) and second wave (21 July to 21 November 2020) were analyzed. RESULTS: A total of 550 and 1191 stroke patients were admitted during the first and second COVID-19 waves, respectively, with an average daily admission rate of nine patients in both waves. During the second wave, there was a decrease in stroke severity (median National Institutes of Health Stroke Scale 5 vs. 6; p = 0.000), in-hospital strokes (3% vs. 8.1%) and in-hospital mortality (9.9% vs. 15.9%). Furthermore, fewer patients experienced concurrent COVID-19 (6.8% vs. 19.1%), and they presented milder COVID-19 and less severe strokes. Fewer hospitals reported a reduction in the number of SU beds or deployment of SU personnel to COVID-19 dedicated wards during the second wave. CONCLUSIONS: During the second COVID-19 wave, fewer stroke patients were diagnosed with COVID-19, and they had less stroke severity and milder COVID-19.

Resumen Introduccion El ictus isquemico puede ser una complicacion grave en los pacientes con infeccion por SARS-CoV-2. Estudiar y caracterizar los diferentes subtipos etiologicos, las caracteristicas clinicas y el pronostico funcional podra resultar util en la seleccion de pacientes para un manejo y tratamiento optimos. Metodos La recogida de variables se hizo de forma retrospectiva en pacientes consecutivos con infeccion por SARS-CoV-2 que desarrollaron un episodio de isquemia cerebral focal (entre el 1 de marzo del 2020 y el 19 de abril del 2020). Se llevo a cabo en un hospital universitario de tercer nivel en la Comunidad de Madrid (Espana). Resultados Durante el periodo de estudio 1.594 pacientes fueron diagnosticados de infeccion por SARS-CoV-2. Identificamos a 22 pacientes con ictus isquemico (1,38%); de estos, no cumplieron los criterios de inclusion 6. Un total de 16 pacientes con isquemia cerebral focal constituyeron la serie del estudio (15 con ictus isquemico y uno con accidente isquemico transitorio). En la valoracion basal en el National Institutes of Health Stroke Scale la mediana fue de 9 (rango intercuartil: 16), la edad media ± desviacion estandar fue de 73 ± 12,8 anos; 12 pacientes fueron varones (75%). El tiempo desde los sintomas de COVID-19 hasta el ictus fue de 13 dias. Se encontro oclusion de gran vaso en 12 pacientes (75%). El dimero-D estuvo elevado en el 87,5% y la proteina C reactiva en el 81,2% de los casos. La etiologia mas frecuente del ictus isquemico fue la aterotrombosis (9 pacientes, 56,3%) con un subtipo predominante que fue el trombo endoluminal sobre placa de ateroma (5 pacientes, 31,2%), 4 de ellos en la arteria carotida interna y uno de ellos en el arco aortico. La mortalidad en nuestra serie fue del 44% (7 de 16 pacientes). Conclusiones En los pacientes con ictus y COVID-19 la etiologia mas frecuente fue la aterotrombotica, con una elevada frecuencia de trombo endoluminal sobre placa de ateroma (31,2% de los pacientes). Nuestros hallazgos clinicos y de laboratorio apoyan la coagulopatia asociada a COVID-19 como un mecanismo etiopatogenico relevante en el ictus isquemico en este contexto.

Background and Purpose: The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non–COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19. Methods: Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge. Results: A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non–COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; P =0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12–3.76] and 3.56 [95% CI, 1.15–11.05], respectively). Conclusions: This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world since it emerged in Wuhan and coronavirus disease 2019 (COVID-19) has become a pandemic1. There is still little information regarding possible neurologic complications of this spread. Herein, we describe a patient with Guillain-Barré syndrome (GBS) preceded by COVID-19, raising the possibility of a causal relationship.

Idiopathic photosensitive occipital lobe epilepsy (IPOE) is a syndrome that should be suspected in patients with seizures with occipital semiology, photosensitivity, and normal MRI. It should be distinguished from occipital epilepsy of unknown aetiology (cryptogenic) given the differences in management. We reviewed patients with occipital seizures which were investigated in our epilepsy unit during the last three years. Three patients were identified with features of IPOE and genetic generalized epilepsy (GGE), formerly known as idiopathic generalized epilepsy, and their clinical characteristics were analysed. We propose the term "idiopathic generalized epilepsy with occipital semiology" based on the significance of managing and treating this syndrome as a GGE.