Ericka Samantha Teleg, MD
European Stroke Organisation-World Stroke Organization 2020 Virtual Conference
November 7-9, 2020
Navigating through this time of a pandemic is challenging enough as we attempt to seek and learn knowledge to compensate for how COVID-19 changes our lives. The special part of the scientific session “COVID-19 Related Stroke,” held during the ESOC-WSO 2020 conference on November 9, was structured brilliantly, led off by Dr. Bernard Yan’s opening.
The session by Karl Shurr and Annie McCluskey of Australia was titled “Rehabilitation for Serious COVID: Physiotherapist as Patient.” Karl’s experiences with COVID teaches us that one can be resilient at this time. He informed us how he used his time in the hospital to motivate himself and hopefully will motivate others, as well. Goal-setting as a motivation is the key in this session. We always ponder on what we cannot do, but his valuable insight as he recovered was “find what the person can do.” Empowerment and kindness are key.
Their session was followed by Dr. Aravinthan Varatharaj of the United Kingdom, titled “Neurological and Neuropsychiatric Complications of COVID-19.” He discussed how COVID-19-related patho-mechanisms cause several neurological manifestations in the setting of critical illness, neuroinflammation, infectious vasculopathy, and direct viral cytopathy. Again, a valuable discussion as we are still unraveling the virus’ effect on the nervous system milieu. This, in effect, is a targeted key point in how we will try to look for specific treatments.
Dr. George Ntaios of Greece followed with an insightful and informative discussion titled “Are Patients with COVID-19 and Acute Ischemic Stroke Different: Characteristics and Outcomes.” Emerging scientific literature are now out there. He summarized what is out there in this session. He enumerated several characteristics of stroke in COVID-19 patients gathered from the literature, namely: This population has an (1) increased in-hospital onset, from Katz et al., Stroke, 2020; (2) They have high NIHSS, from Ntaios and Michel, Stroke, 2020, and Yaghi, Stroke, 2020; (3) They have a predisposition to have large vessel occlusions, from Majdi, Stroke, 2020, and Oxley et al, NEJM, 2020, and others); (4) Multifocal localization; and (5) increased manifestation of acute and/or subacute silent lesions. The take-home messages in his session were that COVID-19 patients have the usual risk factors, more severe strokes, and worse outcomes. He also reiterated what Dr. Varatharaj emphasized, that hyperinflammation perhaps contributes to the underlying pathophysiology and this can be a target for acute stroke intervention in this population.
Dr. Bernard Yan of Australia gave us exciting and new knowledge on his talk on “Next Frontiers in Endovascular Thrombectomy and Some Lessons during the COVID-19 Era.” Stroke pathways and decision-making in each step of the way are changing. He discussed several strategies based on evidence-based guidelines on how we confront patients, particularly those with distal occlusions, low NIHSS, more severe stroke syndromes, from the emergency room to the angiography catheter suite. He discussed this with scenarios giving us moments wherein we analyze, “What if we do nothing?” as he navigated us through an M2 occlusion with a mild stroke syndrome.
The last speaker was Dr. Dipender Gill of the United Kingdom and his session on “Mechanisms – Insights from Genetic Studies.” His overall discussion of interleuking-6 signalling effects on ischemic stroke and other cardiovascular outcomes was suited to guide in treatment approaches in the future. He gave a review of the Mendelian randomization paradigm and the fundamental conditions for a genetic variant to satisfy to be an instrumental variable: (1) The variant (genetic variant) is associated with the exposure; (2) The variant is not associated with any other confounder of the exposure-outcome association; and (3) The variant does not affect the outcome, except via the exposure.
We are all very certain that many physicians, academics, and scientists are grateful for this particular session, as we are all not entirely alone in trying to find a way to combat COVID-19.