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| == University Education == | | == University Education == |
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| *The [[prevalence]] of [[COVID-19]]-associated [[stroke]] varies in different studies
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| {| class="wikitable"
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| |+Prevalence of stroke in patients with COVID-19
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| !Date of publication
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| !Country
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| !Author
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| !Number of patients
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| !Severe infection
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| !Neurological symptoms
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| !Acute Cerebrovascular disease
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| !Ischemic/Hemorrhagic Stroke
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| |-
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| |April 10, 2020
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| |Wuhan, China
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| |Mao et al.<ref name="MaoJin2020">{{cite journal|last1=Mao|first1=Ling|last2=Jin|first2=Huijuan|last3=Wang|first3=Mengdie|last4=Hu|first4=Yu|last5=Chen|first5=Shengcai|last6=He|first6=Quanwei|last7=Chang|first7=Jiang|last8=Hong|first8=Candong|last9=Zhou|first9=Yifan|last10=Wang|first10=David|last11=Miao|first11=Xiaoping|last12=Li|first12=Yanan|last13=Hu|first13=Bo|title=Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China|journal=JAMA Neurology|volume=77|issue=6|year=2020|pages=683|issn=2168-6149|doi=10.1001/jamaneurol.2020.1127}}</ref>
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| |214
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| |88 patients (41.1%), Mean age-58.2 years
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| |78 patients (36.4%)
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| |5 among severe [5.7%] infection group vs 1 [0.8%]) in non-severe group
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| |Ischemic-4, Hemorrhagic-1
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| |-
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| |May 29, 2020
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| |Wuhan, China
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| |Qin et al.<ref name="QinZhou2020">{{cite journal|last1=Qin|first1=Chuan|last2=Zhou|first2=Luoqi|last3=Hu|first3=Ziwei|last4=Yang|first4=Sheng|last5=Zhang|first5=Shuoqi|last6=Chen|first6=Man|last7=Yu|first7=Haihan|last8=Tian|first8=Dai-Shi|last9=Wang|first9=Wei|title=Clinical Characteristics and Outcomes of COVID-19 Patients With a History of Stroke in Wuhan, China|journal=Stroke|volume=51|issue=7|year=2020|pages=2219–2223|issn=0039-2499|doi=10.1161/STROKEAHA.120.030365}}</ref>
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| |1875
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| |461 severe on admission
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| |50 patients ie. 15 among severe and 35 among mild on admission (Median age-70 years), 30 males and 20 females
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| |-
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| |May 20, 2020
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| |New York
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| |Yaghi et al.<ref name="YaghiIshida2020">{{cite journal|last1=Yaghi|first1=Shadi|last2=Ishida|first2=Koto|last3=Torres|first3=Jose|last4=Mac Grory|first4=Brian|last5=Raz|first5=Eytan|last6=Humbert|first6=Kelley|last7=Henninger|first7=Nils|last8=Trivedi|first8=Tushar|last9=Lillemoe|first9=Kaitlyn|last10=Alam|first10=Shazia|last11=Sanger|first11=Matthew|last12=Kim|first12=Sun|last13=Scher|first13=Erica|last14=Dehkharghani|first14=Seena|last15=Wachs|first15=Michael|last16=Tanweer|first16=Omar|last17=Volpicelli|first17=Frank|last18=Bosworth|first18=Brian|last19=Lord|first19=Aaron|last20=Frontera|first20=Jennifer|title=SARS-CoV-2 and Stroke in a New York Healthcare System|journal=Stroke|volume=51|issue=7|year=2020|pages=2002–2011|issn=0039-2499|doi=10.1161/STROKEAHA.120.030335}}</ref>
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| |3556
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| |Ischemic stroke- 32 patients (0.9%)
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| |-
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| |April 28, 2020
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| |New York city
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| |Oxley et al.<ref name="OxleyMocco2020">{{cite journal|last1=Oxley|first1=Thomas J.|last2=Mocco|first2=J.|last3=Majidi|first3=Shahram|last4=Kellner|first4=Christopher P.|last5=Shoirah|first5=Hazem|last6=Singh|first6=I. Paul|last7=De Leacy|first7=Reade A.|last8=Shigematsu|first8=Tomoyoshi|last9=Ladner|first9=Travis R.|last10=Yaeger|first10=Kurt A.|last11=Skliut|first11=Maryna|last12=Weinberger|first12=Jesse|last13=Dangayach|first13=Neha S.|last14=Bederson|first14=Joshua B.|last15=Tuhrim|first15=Stanley|last16=Fifi|first16=Johanna T.|title=Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young|journal=New England Journal of Medicine|volume=382|issue=20|year=2020|pages=e60|issn=0028-4793|doi=10.1056/NEJMc2009787}}</ref>
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| |5
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| |Large vessel stroke-5, Mean age-<50 years
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| |-
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| |July 12, 2020
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| |United Kingdom
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| |Menni et al.<ref name="MenniValdes20202">{{cite journal|last1=Menni|first1=Cristina|last2=Valdes|first2=Ana|last3=Freydin|first3=Maxim B|last4=Ganesh|first4=Sajaysurya|last5=El-Sayed Moustafa|first5=Julia|last6=Visconti|first6=Alessia|last7=Hysi|first7=Pirro|last8=Bowyer|first8=Ruth C E|last9=Mangino|first9=Massimo|last10=Falchi|first10=Mario|last11=Wolf|first11=Jonathan|last12=Steves|first12=Claire|last13=Spector|first13=Tim|year=2020|doi=10.1101/2020.04.05.20048421}}</ref>
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| |579
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| |59.41%
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| |}<br />
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| === University Education ===
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| [[Syncope (medicine)|Syncope]] is classified yo three categories:
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| *[[Vasovagal]]
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| * Neurogenic
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| * Cardiovascular.
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| {{Family tree | | | | A01 |~| A02 | |A01= Box 1 in Row 1| A02= Box in Row 1}}
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| {{Family tree | | | | A01 | | | |A01= Box 1 in Row 1}}
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| {{Family tree | | | | |!| | | | | }}
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| {{Family tree | | | | |!| | | | | }}
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| {{Family tree | | | | B01 | | | |B01= Box 2 in Row 2}}
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| {{Family tree/start}}
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| {{Family tree | | | | A01 | | | |A01= Box 1 in Row 1}}
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| {{Family tree | | | | |!| | | | | }}
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| {{Family tree | | | | B01 | | | |B01= Box 2 in Row 2}}
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| {{Family tree | |,|-|-|^|-|-|.| | }}
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| {{Family tree | C01 | | | | C02 |C01= Box 3 in Row 3| C02= Box 4 in Row 4}}
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| {{Family tree/end}}
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| [[File:Covid-19-pneumonia-101.png|300 px|thumb|center|Case courtesy of Dr Subhan Iqbal, Radiopaedia.org, rID: 76341]]
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| <br />
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| {| class="wikitable"
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| ! colspan="4" |DDx of syncope
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| |}
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| <references />
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| {| class="wikitable"
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" rowspan="2" |<small>Patient</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" rowspan="2" |<small>Past Medical History</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" rowspan="2" |<small>Later presentation</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" rowspan="2" |<small>GCS</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" colspan="2" |<small>Lab. Findings</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" rowspan="2" |<small>Specific Tests</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" colspan="2" |<small>Imaging studies</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>CBC</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>CSF</small>
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>MRI/CT scan</small>
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| |1. 84-year old man in France presented with [[dyspnea]] and [[cough]]'''<ref name="ZayetKlopfenstein2020">{{cite journal|last1=Zayet|first1=Souheil|last2=Klopfenstein|first2=Timothée|last3=Kovẚcs|first3=Róbert|last4=Stancescu|first4=Silviu|last5=Hagenkötter|first5=Beate|title=Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020|journal=Emerging Infectious Diseases|volume=26|issue=9|year=2020|issn=1080-6040|doi=10.3201/eid2609.201791}}</ref>'''
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| |[[Diabetes Mellitus]],
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| [[Hypertension]],
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| [[Atrial fibrillation]],
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| [[Peripheral Arterial Disease]],
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| [[Coronary Heart Disease]]
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| |Worsening [[headache]], [[Sore throat|Sore throat.]] (Day 5)
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| Impaired [[consciousness]] and transient [[generalized seizure]], (Day 9)
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| |E4V1M1
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| |↑[[WBC|WBCs]] and [[neutrophils]]<br />↓[[lymphocytes]]
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| ↑ [[CRP]]
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| |Clear and colorless fluid,
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| [[Pressure]]=320 mmH<sub>2</sub>O,
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| [[Cell]] count was 12/μL–10
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| [[Mononuclear cells|mononuclear]] and 2 [[polymorphonuclear cells]]
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| |[[Reverse transcriptase PCR|RT-PCR]] for [[SARS-CoV-2]] was positive in [[Nasopharyngeal|nasopharyngea]]<nowiki/>l [[Swabbing|swab]]
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| |Brain [[MRI]]:
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| Hyperintensity in the right lateral [[Ventricle|ventricle's]] inferior horn along the wall,
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| pan-[[Paranasal sinus|paranasal]] [[sinusitis]].
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| |-
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| |2. 74-year old man in France presented with confusion and influenza-like illness<ref name="ZayetKlopfenstein2020">{{cite journal|last1=Zayet|first1=Souheil|last2=Klopfenstein|first2=Timothée|last3=Kovẚcs|first3=Róbert|last4=Stancescu|first4=Silviu|last5=Hagenkötter|first5=Beate|title=Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020|journal=Emerging Infectious Diseases|volume=26|issue=9|year=2020|issn=1080-6040|doi=10.3201/eid2609.201791}}</ref>
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| |[[Flu]] like [[Symptom|symptoms]]
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| |[[Headache]], [[nausea]], [[dizziness]], and
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| drug-[[refractory]] [[seizure]]<nowiki/>s.
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| |E4V5M6
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| |NA
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| |NA
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| |[[RT-PCR]] and [[antibody tests]] positive
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| |Brain [[MRI]]: Hyperintensity in the left [[temporal lobe]].
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| MR [[Spectroscopy]]: Decrease [[N-acetyl aspartate]] peak along with a marked elevated [[choline]] peak.
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| |-
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| |3. 31-year-old African American woman<ref name="pmid32487282">{{cite journal| author=Benameur K, Agarwal A, Auld SC, Butters MP, Webster AS, Ozturk T | display-authors=etal| title=Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020. | journal=Emerg Infect Dis | year= 2020 | volume= 26 | issue= 9 | pages= | pmid=32487282 | doi=10.3201/eid2609.202122 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32487282 }}</ref>
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| |[[SCD]] patient with [[dyspnea]]
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| |[[Paralysis]] and [[sedation]] (Day 13)
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| [[Comatose]] (Day 15) and death (Day 16)
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| |E0V0M0
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| |NA
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| |[[Pressure]]=30cmH<sub>2</sub>O
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| 115 nucleated cell /ml
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| 7374 [[erythrocytes]]
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| /ml
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| [[Protein]]> 200mg/dl
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| <br />
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| |[[Reverse transcriptase PCR|RT=PCR]] for [[SARS-CoV-2]] was positive in [[Nasopharyngeal|nasopharyngea]]<nowiki/>l [[Swabbing|swab]]
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| |Brain [[MRI]]: Nonenhancing [[cerebral edema]] and restricted [[diffusion]] in the right [[cerebral hemisphere]] with [[brain herniation]].
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| |}
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