Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young (NEJM 28th April)
5 cases reported from NYC area in under 50s
1 woman, 4 men
Large vessel ischaemic stroke
SARS-CoV-2 infection was diagnosed in all five
Patient 1
33-year-old woman, previously healthy
Cough, headache, and chills lasting 1 week
Progressive dysarthria
Numbness and weakness in the left arm and left leg over 28 hours
Right middle cerebral artery
COVID lung involvement
Antiplatelet therapy then anticoagulation therapy.
Repeat CT angiography on hospital day 10 showed complete resolution of the thrombus
Discharged to rehabilitation
By comparison, every 2 weeks over the previous 12 months, our service has treated, on average, 0.73 patients younger than 50 years of age with large-vessel stroke.
Wuhan, incidence of stroke among hospitalized patients with Covid-19 was approximately 5%, (youngest 55)
Large-vessel stroke was reported, 2004 SARS-CoV-1, Singapore
Coagulopathy and vascular endothelial dysfunction have been proposed as complications of Covid-19.
The association between large-vessel stroke and Covid-19 in young patients requires further investigation.
Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic.
Vit D in Indonesia
Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study (26th April)
Retrospective cohort study which included two cohorts (active and expired) of
780 cases with laboratory-confirmed infection of SARS-CoV-2 in Indonesia
Age, sex, co-morbidity, Vitamin D status, and disease outcome (mortality) were recorded
Serum 25(OH) D levels
1. Normal, greater than 30 ng/ml
2. Insufficient, 21-29 ng/ml
3. Deficient, less than 20 ng/ml. This
Results
Death risk factors, male, increasing age, pre-existing condition, below normal Vitamin D serum level
When controlling for age, sex, and comorbidity, Vitamin D status is strongly associated with COVID-19 mortality outcome of cases.
When compared to cases with normal Vitamin D status, death was approximately 10.12 times more likely for Vitamin D deficient cases (OR=10.12; p less than 0.001).
