Faculty Bibliography
Searched for:
person:labovd01
Total Results:
64
COVID-19-Associated Carotid Atherothrombosis and Stroke
We present a radiology-pathology case series of 3 patients with coronavirus disease 2019 (COVID-19) with acute ischemic stroke due to fulminant carotid thrombosis overlying mild atherosclerotic plaque and propose a novel stroke mechanism: COVID-associated carotid atherothrombosis.
PMID: 32819896
ISSN: 1936-959x
CID: 4567672
Journal of stroke & cerebrovascular diseases. 2020:29(10).DOI: 10.1016/j.jstrokecerebrovasdis.2020.105114
The effect of COVID-19 on stroke hospitalizations in New York City
BACKGROUND:Little is known about the effect of the Coronavirus disease 2019 pandemic on stroke care and the impact of the epidemic on acute stroke hospitalizations has not been described. METHODS:We analyze the stroke admission rate in three hospitals in New York City from January 1, 2020 through April 17, 2020, identifying all cases of acute ischemic stroke, intraparenchymal hemorrhage and subarachnoid hemorrhage. RESULTS:We confirmed 518 cases of out-of-hospital stroke. During the baseline period up to February 25, 2020, the daily stroke admission rate was stable, with the slope of the regression describing the number of admissions over time equal to -0.33 (se = 1.21), not significantly different from 0 (p = 0.79), with daily admissions averaging 41. During the pandemic period, the slope was -4.4 (se = 1.00); i.e., the number of stroke admissions decreased an average of 4.4 per week, (p = 0.005), with weekly admissions averaging 23, a reduction of 44% versus baseline. This general result was not different by patient age, sex, or race/ethnicity. CONCLUSIONS:The weekly stroke admission rate started declining two weeks prior to the local surge of coronavirus admissions. The consequences of lack of diagnosis and treatment of a large proportion of acute stroke patients are likely severe and lasting.
PMID: 32912527
ISSN: 1532-8511
CID: 4589532
Folding a neuroscience center into streamlined Covid-19 response teams: Lessons in origami
In response to the Covid-19 pandemic epicenter in Bronx NY, our Neuroscience center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house-staff. In healthcare, we rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with Covid-19, provide high quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of healthcare teams, particularly house-staff and colleagues who are most vulnerable. In our attempt to balance these principles, over three weeks, we reformatted our inpatient neuroscience services by reducing from four wards to just one, still delivering care to over 600 hospitalized neuro-covid patients and over 1742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of Covid patients in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices and emerging research will help us with insights toward an evidence-based approach to neurologic care during and after the Covid-19 pandemic.
PMID: 32732292
ISSN: 1526-632x
CID: 4540532
Stroke Epidemiology and Intersectionality: Understanding Stroke Outcomes in Mexican Americans in Corpus Christi [Editorial]
PMID: 32867600
ISSN: 1524-4628
CID: 4582922
Misdiagnosis of Cervicocephalic Artery Dissection in the Emergency Department
Background and Purpose- Cervicocephalic artery dissection is an important cause of stroke. The clinical presentation of dissection can resemble that of benign neurological conditions leading to delayed or missed diagnosis. Methods- We performed a retrospective cohort study using statewide administrative claims data from all Emergency Department visits and admissions at nonfederal hospitals in Florida from 2005 to 2015 and New York from 2006 to 2015. Using validated International Classification of Diseases, Ninth Revision, CM codes, we identified adult patients hospitalized for cervicocephalic artery dissection. We defined probable misdiagnosis of dissection as having an Emergency Department treat-and-release visit for symptoms or signs of dissection, including headache, neck pain, and focal neurological deficits in the 14 days before dissection diagnosis. Multivariable logistic regression was used to compare adverse clinical outcomes in patients with and without probable misdiagnosis. Results- Among 7090 patients diagnosed with a dissection (mean age 52.7 years, 44.9% women), 218 (3.1% [95% CI, 2.7%-3.5%]) had a preceding probable Emergency Department misdiagnosis. After adjustment for demographics and vascular risk factors, there were no differences in rates of stroke (odds ratio, 0.82 [95% CI, 0.62-1.09]) or in-hospital death (odds ratio, 0.26 [95% CI, 0.07-1.08]) between dissection patients with and without a probable misdiagnosis at index hospitalization. Conclusions- We found that ≈1 in 30 dissection patients was probably misdiagnosed in the 2 weeks before their diagnosis.
PMID: 32295512
ISSN: 1524-4628
CID: 4383582
Varicella Zoster Virus Vasculitis and Adult Cerebrovascular Disease
The role of Varicella zoster virus (VZV) in neurological illness, particularly cerebrovascular disease, has been increasingly recognized. Primary infection by VZV causes varicella (chickenpox), after which the virus remains latent in neuronal ganglia. Later, during aging or immunosuppression, the virus can reactivate causing zoster (shingles). Virus reactivation can also spread to cerebral arteries causing vasculitis and stroke. Zoster is a recognized risk factor for stroke, but stroke can occur without preceding zoster rash. The diagnosis of VZV cerebral vasculitis is established by abnormal brain imaging and confirmed by presence of viral DNA or anti-VZV antibodies in cerebrospinal fluid. Treatment with acyclovir with or without prednisone is usually recommended. VZV vasculitis is a unique and uncommon stroke mechanism that has been under recognized. Careful diagnostic investigation may be warranted in a subgroup of patients with ischemic stroke to detect VZV vasculitis and initiate appropriate therapy. In the following review, we detail the clinical presentation of VZV vasculitis, diagnostic challenges in VZV detection, and suggest the ways to enhance recognition and treatment of this uncommon disease.
PMCID:6739663
PMID: 31534609
ISSN: 1941-8744
CID: 4089422
Clinical Decision-Making for Thrombolysis of Acute Minor Stroke Using Adaptive Conjoint Analysis
Introduction/UNASSIGNED:There is practice variability in the treatment of patients with minor ischemic stroke with thrombolysis. We sought to determine which clinical factors physicians prioritize in thrombolysis decision-making for minor stroke using adaptive conjoint analysis. Methods/UNASSIGNED:tests. Statistical significance was set at α = .05. Results/UNASSIGNED:Fifty-four participants completed the survey; 61% were vascular neurologists and 93% worked in academic centers. All neurological deficits were ranked higher than age, premorbid status, or potential contraindications to thrombolysis. Differences between each successive mean preference weight were significant: motor (31.7%, standard deviation [SD]: 9.5), language/speech (24.1%, SD: 9.6), other neurological deficits (16.6%, SD: 6.4), premorbid status (12.9%, SD: 6.6), age (10.1%, SD: 6.3), and potential thrombolysis contraindication (4.7%, SD: 4.4). Conclusion/UNASSIGNED:In a conjoint analysis, surveyed US physicians in academic practice assigned greater weight to motor and speech/language deficits than other neurological deficits, patient age, relative contraindications to thrombolysis, and premorbid disability when deciding to thrombolyse patients with minor stroke.
PMCID:6327243
PMID: 30671158
ISSN: 1941-8744
CID: 3609592
Journal of stroke & cerebrovascular diseases. 2018:27(5):1363-1367.DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.024
The Effect of Being Found with Stroke Symptoms on Predictors of Hospital Arrival
BACKGROUND:Studies examining predictors of delay in hospital arrival after stroke symptom onset have not accounted for patients who are found with their symptoms and cannot seek help independently. Our objective is to show that inclusion of patients who are "found down" in studies of prehospital delay biases the estimated association of sociodemographic and clinical variables with time of hospital arrival. METHODS:We performed a retrospective analysis of sociodemographic and clinical characteristics of patients with acute ischemic stroke presenting to a tertiary care hospital in the Bronx, New York. RESULTS:Compared with all other patients with acute ischemic stroke (N = 1784), patients who were found down (N = 120) were more likely to be older (75  ± 13 years versus 68 ± 14 years, P < .0001), female (68% versus 53%, P = .003), Caucasian race (P < .001), have higher socioeconomic status (P = .001), more severe stroke deficits (P < .0001), use emergency medical services (P < .001), and arrive to the hospital more than 3 hours after symptom onset (P < .001). Inclusion of patients who were found down in a model predicting delay in hospital arrival decreased the strength of the association between the predictors and the outcome. CONCLUSIONS:Being found with stroke symptoms confounds the association of sociodemographic and clinical variables with time of hospital arrival. Studies of predictors of prehospital delay should therefore exclude patients who are found down.
PMID: 29428327
ISSN: 1532-8511
CID: 2990072
Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes
Stroke has multiple etiologies, but the underlying genes and pathways are largely unknown. We conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 cases and 454,450 controls) and discovered 22 new stroke risk loci, bringing the total to 32. We further found shared genetic variation with related vascular traits, including blood pressure, cardiac traits, and venous thromboembolism, at individual loci (n = 18), and using genetic risk scores and linkage-disequilibrium-score regression. Several loci exhibited distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology, with prioritization of risk variants and genes accomplished through bioinformatics analyses using extensive functional datasets. Stroke risk loci were significantly enriched in drug targets for antithrombotic therapy.
PMCID:5968830
PMID: 29531354
ISSN: 1546-1718
CID: 2992602
Charting the Course: Risk Scores for Major Bleeding in Transient Ischemic Attack and Ischemic Stroke [Comment]
PMID: 29459392
ISSN: 1524-4628
CID: 2990802
