During the current coronavirus disease (COVID-19) pandemic the primary focus has been on infected patients and the frontline responders, and this was associated with a reduction of 45% of total admissions to a Stroke Unit in Italy compared to the same period in 2019, with a higher prevalence of severe stroke at admission, according to study results published in  the Journal of the Neurological Sciences.

In light of the changes inflicted by the COVID-19 pandemic, the researchers sought to explore the effects of the pandemic on stroke management during the first month of Italy’s lockdown, between March 9 and April 9, 2020.

The retrospective study included all 16 adults (mean age 77 years) hospitalized to the Stroke Unit of the University Medical Hospital of Trieste during the COVID-19 pandemic with symptoms compatible with acute stroke and the researchers compared the clinical features and outcomes of these patients to 29 patients (mean age 78 years) hospitalized to the Stroke Unit in the same period of 2019. All the patients were tested negative to SARS-CoV-2.

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The groups were similar with regards to demographic characteristics and stroke subtypes. However, the researchers stressed the 45% reduction of total admissions, from 29 patients hospitalized in 2019 to 16 patients admitted during the recent lockdown.

The prevalence of severe stroke, defined as NIH stroke scale >10 was higher in the 2020 cohort, compared to those hospitalized in 2019 (50% vs 28%, respectively). In addition, the mean length of hospital stay was shorter in the COVID-19 era, compared to 2019. The researchers suggest that the more severe clinical presentation and the faster time course to discharge might be the cause for the worse functional outcomes in the recent cohort, despite a similar proportion of treated patient in 2019 and 2020.

The emergency structured pathway for acute stroke included separated emergency department and Stroke Unit areas, along with extensive and early use of swabs. This approach allowed the medical teams to offer effective and timely reperfusion treatments to appropriate patients while protect the staff and other inpatients from infection.

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Stroke of unknown symptom onset was more common in the 2020 cohort (50% vs 10%) and the number of patients that were discharged following a complete stroke work-up was lower, compared to those admitted in 2019 (31% vs 69%, respectively).

“The adopted strategies for stroke management during the COVID-19 emergency have suggested being effective, while suffering a reduced and delayed reporting of symptoms,” concluded the researchers.


Naccarato M, Scali I, Olivo S, et al. Has COVID-19 played an unexpected “stroke” on the chain of survival? [published online 4 May 2020]. J Neurol Sci. doi: 10.1016/j.jns.2020.116889