The emotional impact of social distancing in general Romanian population during COVID-19 pandemic

Background and aims: Coronavirus SARS-CoV-2 is currently the major public health concern worldwide with systemic complications, including thrombotic and hemorrhagic neurological manifestations. Methods: We report a series of patients admitted in the stroke unit of neurology department of the Military Hospital of Tunis in November 2020, presented with cerebrovascular symptoms as an initial presentation of SARS-CoV-2. Clinical characteristics and outcome of the patients are described. Results: Seven patients were included. Infection with SARS-CoV-2 was diagnosed through reverse transcription polymerase chain reaction (RT-PCR) of tracheal aspirate and a chest computed tomography (CT) scan. The main cerebrovascular manifestations are: acute ischemic stroke (AIS) in five patients, intracerebral hemorrhage in one case, with a left capsulo thalamic localization. One patient presented with cerebral venous thrombosis (CVT) in the left sigmoid sinus. All patients with AIS received antiplatelet therapy and statins. Treatment of COVID-19 infection with antibiotics, vitamins and preventive anticoagulant has been initiated. three patients developed dyspnea and oxygen desaturation with need of Oxygen support by face mask. One patient was transferred to the intensive care unit and required intubation, and one patient died after two days. The patient with CVT was started on full anticoagulation with unfractionated heparin relayed by oral anticoagulants. After one week, she was stabilized. Conclusion: SARS-CoV-2 is a major risk factor for cerebrovascular disease. Better understanding of these complications is urgent in order to improve the management of these patients.