Abstract
In literature, it has been suggested that SARS-CoV-2's impact on the heart and brain may contribute to immune-mediated thrombosis, the renin-angiotensin system related to the pathogenesis of ischemic stroke. Our study compares the rehabilitation outcomes of stroke patients with and without a history of COVID-19. Our study aims to compare rehabilitation results of COVID-19-associated ischemic stroke patients and non-COVID-19 patients, as thrombotic complications and ischemic stroke have largely been reported since the pandemic's beginning. This study included 83 stroke patients aged 18-80 years who were hospitalized and rehabilitated. Patients' age, gender, lesion location, Brunnstrom stage, ambulation level, comorbidities, Charlson comorbidity index, stroke type, pre-stroke history of COVID-19 and symptoms, previous stroke history, and duration of physical therapy program were recorded. Those with a history of COVID-19 reverse transcriptase polymerase chain reaction test being positive and/or a history of pneumonia compatible with COVID-19 on thoracic computed tomography examination (28 patients) were included in the COVID-19 group while those without those conditions were included in the non-COVID-19 group (55 patients). Factors contributing to rehabilitation results were compared between the groups. The rehabilitation outcomes were similar across the groups, with no differences in ambulation levels or Brunnstrom staging (hand, upper and lower extremities) (p values 0.237, 0.155, 0.380, 0.192, respectively). However, the COVID-19 group had higher rates of ischemic heart disease and hypothyroidism, no prior history of cerebrovascular accident, more periventricular infarctions, and initially more adversely affected ambulation levels (p values 0.047, 0.038, 0.042, 0.037, 0.028, respectively). The study concluded that there was no apparent difference between the two groups' outcome parameters. Although the COVID-19 group's ambulation level was initially more negatively impacted, no detrimental effects on rehabilitation outcomes were found.
Ethical Statement
The authors declare no conflict of interest.
Supporting Institution
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Thanks
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References
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- Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID‐19. Thromb Res. 2020;191:145‐147.
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- Wade DT. Measurement in neurological rehabilitation. Curr Opin Neurol Neurosurg. 1992;5(5):682–6.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373–83.
- Ashrafi F, Zali A, Ommi D, Salari M, Fatemi A, Arab-Ahmadi M, et al. COVID-19-related strokes in adults below 55 years of age: a case series. Neurol Sci. 2020;41(8):1985-1989.
- Avula A, Nalleballe K, Narula N, Sapozhnikov S, Dandu V, Toom S, et al. COVID-19 presenting as stroke. Brain Behav Immun. 2020;87:115-119.
- Grau AJ, Buggle F, Becher H, Zimmermann E, Spiel M, Fent T, et al. Recent bacterial and viral infection is a risk factor for cerebrovascular ischemia: clinical and biochemical studies. Neurology. 1998;50(1):196–203.
- Luo W, Liu X, Bao K, Huang C. Ischemic stroke associated with COVID-19: a systematic review and meta-analysis. J Neurol. 2022;269(4):1731-1740.
- Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke 2001;32(12):2735-40.
- Adams HP. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41.
- Egbert AR, Cankurtaran S, Karpiak S. Brain abnormalities in COVID-19 acute/subacute phase: A rapid systematic review. Brain Behav Immun. 2020;89:543-554.
- Altiparmak T, Can C, Hazal SC. COVID-19 hastalarında iskemik inme: Tek merkezin bir yıllık tecrübesi. Turk Beyin Damar Hastaliklari Dergisi 2022; 28(1): 23-30.
- Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurology. 2020; 77: 683- 690.
- Zhang R, Hao Y, Wang Y, Yang H. Significant association between ischemic heart disease and elevated risk for COVID-19 mortality: A meta-analysis. Am J Emerg Med. 2022;55:95-97.
- Zhang S, Zhang J, Wang C, Chen X, Zhao X, Jing H, et al. COVID 19 and ischemic stroke: Mechanisms of hypercoagulability (Review). Int J Mol Med 2021; 47(3): 21.
- Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol 2020; 5(3): 279- 284.
- Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions. Stroke 2020; 51(7): 1996-2001.
- Burekovic A, Halilovic D, Sahbaz A. Hypothyroidism and Subclinical Hypothyroidism as a Consequence of COVID-19 Infection. Med Arch. 2022;76(1):12-16.
- Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):767-783.
- Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES, et al. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis. 2020;50(3):587-595.
- Fleming C, Chakraborty A, Jaiswal T, Patel P, Nair S. Onset of stroke in patients with post-COVID-19 syndrome following hospitalization for severe COVID-19 infection: a systematic literature review. Value Health. 2022;25(1):S121
Abstract
References
- Qureshi AI, Baskett WI, Huang W, Shyu D, Myers D, Raju M, et al. Acute Ischemic Stroke and COVID-19: An Analysis of 27 676 Patients. Stroke. 2021;52(3):905-912.
- Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID‐19. Thromb Res. 2020;191:145‐147.
- Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large‐vessel stroke is a presenting feature of COVID-19 in the young. N Engl J Med. 2020;382:e60.
- Sagris D, Papanikolaou A, Kvernland A, Korompoki E, Frontera JA, Troxel AB, et al. COVID-19 and ischemic stroke. Eur J Neurol. 2021;28(11):3826-3836.
- Ahmad SJ, Feigen CM, Vazquez JP, Kobets AJ, Altschul DJ. Neurological Sequelae of COVID-19. J Integr Neurosci. 2022;21(3):77.
- Wade DT. Measurement in neurological rehabilitation. Curr Opin Neurol Neurosurg. 1992;5(5):682–6.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373–83.
- Ashrafi F, Zali A, Ommi D, Salari M, Fatemi A, Arab-Ahmadi M, et al. COVID-19-related strokes in adults below 55 years of age: a case series. Neurol Sci. 2020;41(8):1985-1989.
- Avula A, Nalleballe K, Narula N, Sapozhnikov S, Dandu V, Toom S, et al. COVID-19 presenting as stroke. Brain Behav Immun. 2020;87:115-119.
- Grau AJ, Buggle F, Becher H, Zimmermann E, Spiel M, Fent T, et al. Recent bacterial and viral infection is a risk factor for cerebrovascular ischemia: clinical and biochemical studies. Neurology. 1998;50(1):196–203.
- Luo W, Liu X, Bao K, Huang C. Ischemic stroke associated with COVID-19: a systematic review and meta-analysis. J Neurol. 2022;269(4):1731-1740.
- Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke 2001;32(12):2735-40.
- Adams HP. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41.
- Egbert AR, Cankurtaran S, Karpiak S. Brain abnormalities in COVID-19 acute/subacute phase: A rapid systematic review. Brain Behav Immun. 2020;89:543-554.
- Altiparmak T, Can C, Hazal SC. COVID-19 hastalarında iskemik inme: Tek merkezin bir yıllık tecrübesi. Turk Beyin Damar Hastaliklari Dergisi 2022; 28(1): 23-30.
- Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurology. 2020; 77: 683- 690.
- Zhang R, Hao Y, Wang Y, Yang H. Significant association between ischemic heart disease and elevated risk for COVID-19 mortality: A meta-analysis. Am J Emerg Med. 2022;55:95-97.
- Zhang S, Zhang J, Wang C, Chen X, Zhao X, Jing H, et al. COVID 19 and ischemic stroke: Mechanisms of hypercoagulability (Review). Int J Mol Med 2021; 47(3): 21.
- Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol 2020; 5(3): 279- 284.
- Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions. Stroke 2020; 51(7): 1996-2001.
- Burekovic A, Halilovic D, Sahbaz A. Hypothyroidism and Subclinical Hypothyroidism as a Consequence of COVID-19 Infection. Med Arch. 2022;76(1):12-16.
- Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):767-783.
- Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES, et al. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis. 2020;50(3):587-595.
- Fleming C, Chakraborty A, Jaiswal T, Patel P, Nair S. Onset of stroke in patients with post-COVID-19 syndrome following hospitalization for severe COVID-19 infection: a systematic literature review. Value Health. 2022;25(1):S121
Details
| Primary Language | English |
|---|---|
| Subjects | Neurology and Neuromuscular Diseases |
| Journal Section | Research Article |
| Authors | |
| Publication Date | March 29, 2024 |
| Submission Date | November 21, 2023 |
| Acceptance Date | March 14, 2024 |
| Published in Issue | Year 2024 Volume: 41 Issue: 1 |
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