2024
Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion
Mak A, Matouk C, Avery E, Behland J, Haider S, Frey D, Madai V, Vajkoczy P, Griessenauer C, Zand R, Hendrix P, Abedi V, Sanelli P, Falcone G, Petersen N, Sansing L, Sheth K, Payabvash S, Malhotra A. Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion. PLOS ONE 2024, 19: e0304962. PMID: 38870240, PMCID: PMC11175522, DOI: 10.1371/journal.pone.0304962.Peer-Reviewed Original ResearchConceptsDiffusion-weighted imagingLarge vessel occlusionIrreversible ischemic changesPoor functional outcomeFunctional outcomesIschemic changesInfarct volumeAlberta Stroke Program Early CT ScorePredicting poor functional outcomeVessel occlusionFollow-up diffusion-weighted imagingAnterior circulation LVO strokeCTA source imagesReceiver operating characteristic curveExpert human readersPredicting final infarctionASPECTS regionsAdmission CTANon-inferior performanceBaseline CTACT scoreFinal infarctEndovascular therapyHU attenuationValidation cohort
2023
Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke
Forman R, Okumu R, Mageid R, Baker A, Neu D, Parker R, Peyravi R, Schindler J, Sansing L, Sheth K, de Havenon A, Jasne A, Narula R, Wira C, Warren J, Sharma R. Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke. Neurology 2023, 102: e207764. PMID: 38165368, PMCID: PMC10834135, DOI: 10.1212/wnl.0000000000207764.Peer-Reviewed Original ResearchConceptsEmergency department arrival timesEmergency medical servicesLate presentationAcute ischemic stroke therapyYale-New Haven HospitalGuidelines-Stroke registryNeighborhood-level socioeconomic factorsPatient-level factorsRetrospective observational studyIschemic stroke therapyMixed-effects logistic regression modelNon-white patientsNon-white raceUnivariate logistic regressionNew Haven HospitalLogistic regression modelsHospital presentationTreatment ineligibilityStroke RegistryAcute strokeHospital arrivalStroke therapyUnivariate analysisObservational studyPatientsTrained immunity induced by high‐salt diet impedes stroke recovery
Lin T, Jiang D, Chen W, Lin J, Zhang X, Chen C, Hsu C, Lai L, Chen P, Yang K, Sansing L, Chang C. Trained immunity induced by high‐salt diet impedes stroke recovery. EMBO Reports 2023, 24: e57164. PMID: 37965920, PMCID: PMC10702837, DOI: 10.15252/embr.202357164.Peer-Reviewed Original ResearchConceptsInnate immune memoryMonocyte-derived macrophagesStroke recoveryInflammatory responseBone marrowImmune memoryHigh-salt dietCause of morbidityInitial inflammatory responsePotential therapeutic targetLoss of Nr4a1Stroke outcomeStroke brainIntracerebral hemorrhageBrain recoverySterile inflammationHealthy miceTissue injurySevere formTherapeutic targetAlternative activationImmune primingReparative functionsProgenitor cellsNR4A familyPolygenic Susceptibility to Hypertension and Blood Pressure Control in Stroke Survivors
Acosta J, Both C, Demarais Z, Conlon C, Leasure A, Torres-Lopez V, de Havenon A, Petersen N, Gill T, Sansing L, Sheth K, Falcone G. Polygenic Susceptibility to Hypertension and Blood Pressure Control in Stroke Survivors. Neurology 2023, 100: e1587-e1597. PMID: 36690452, PMCID: PMC10103110, DOI: 10.1212/wnl.0000000000206763.Peer-Reviewed Original ResearchConceptsWorse BP controlUncontrolled blood pressureDiastolic blood pressureBlood pressureStroke survivorsPolygenic risk scoresBP controlPolygenic susceptibilityMean diastolic blood pressureMean systolic blood pressureStroke Prevention TrialBlood pressure controlSystolic blood pressureResistant hypertensionVascular eventsHemorrhagic strokePrevention trialsVitamin InterventionMultivariable modelRisk scoreGenetic predispositionPressure controlLogistic regressionSurvivorsHypertensionEmbracing Heterogeneity in The Multicenter Stroke Preclinical Assessment Network (SPAN) Trial
Morais A, Locascio J, Sansing L, Lamb J, Nagarkatti K, Imai T, van Leyen K, Aronowski J, Koenig J, Bosetti F, Lyden P, Ayata C, Bosetti F, Koenig J, Lyden P, Lamb J, Nagarkatti K, Hess D, Kamat P, Khan M, Dhandapani K, Arbab A, Siddiqui S, Smith C, Nisar M, Leira E, Chauhan A, Dhanesha N, Patel R, Kumskova M, Thedens D, Wang K, Ayata C, Morais A, Imai T, Qin T, Jin X, Erdogan T, Yu L, Mandeville J, Kimberly W, Whittier J, Lo E, Arai K, Van Leyen K, Sansing L, Hyder F, Mihailovic J, Sanganahalli B, Diaz-Perez S, Velazquez S, Beatty H, Johnson C, Herman A, Boisserand L, Immakavar E, Koehler R, Dawson T, Dawson V, Shi Y, Avery B, Lannon S, Bibic A, Akhter K, Karuppagounder S, Aronowski J, McCullough L, Obertas L, Goh A, Huang S, Chauhan A. Embracing Heterogeneity in The Multicenter Stroke Preclinical Assessment Network (SPAN) Trial. Stroke 2023, 54: 620-631. PMID: 36601951, PMCID: PMC9870939, DOI: 10.1161/strokeaha.122.040638.Peer-Reviewed Original ResearchConceptsTotal anesthesia durationAnesthesia durationIndependent predictorsMultivariable analysisClinical trialsTransient focal cerebral ischemiaFocal cerebral ischemiaCerebral blood flowLaser Doppler flowCentralized randomizationModified intentionTreat populationExperimental strokeCerebral ischemiaDoppler flowRodent modelsMCAOBlood flowNetwork trialFlow dropPreclinical trialsMouse cohortsStudy designTrialsTrial onsetRole of Inflammatory Processes in Hemorrhagic Stroke
Ohashi S, DeLong J, Kozberg M, Mazur-Hart D, van Veluw S, Alkayed N, Sansing L. Role of Inflammatory Processes in Hemorrhagic Stroke. Stroke 2023, 54: 605-619. PMID: 36601948, DOI: 10.1161/strokeaha.122.037155.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsHemorrhagic strokeIntracerebral hemorrhageInflammatory processCerebral amyloid angiopathy-related haemorrhageAngiopathy-related hemorrhageRole of inflammationCerebral amyloid angiopathyInflammatory immune responseEffective therapeutic strategyCentral nervous systemBrain residentAmyloid angiopathyImmune cellsTissue injuryCommon causeImmune responseHemorrhageTherapeutic strategiesNervous systemMajor subtypesDisease pathologyStrokeOlder individualsTissue recoveryDeadliest form
2022
2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association
Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS, Association O. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2022, 53: e282-e361. PMID: 35579034, DOI: 10.1161/str.0000000000000407.Peer-Reviewed Original ResearchCT angiographic radiomics signature for risk stratification in anterior large vessel occlusion stroke
Avery EW, Behland J, Mak A, Haider SP, Zeevi T, Sanelli PC, Filippi CG, Malhotra A, Matouk CC, Griessenauer CJ, Zand R, Hendrix P, Abedi V, Falcone GJ, Petersen N, Sansing LH, Sheth KN, Payabvash S. CT angiographic radiomics signature for risk stratification in anterior large vessel occlusion stroke. NeuroImage Clinical 2022, 34: 103034. PMID: 35550243, PMCID: PMC9108990, DOI: 10.1016/j.nicl.2022.103034.Peer-Reviewed Original ResearchConceptsLarge vessel occlusion strokeIndependent cohortPrognostication toolsMechanical thrombectomyRisk stratificationOcclusion strokeExternal cohortAnterior circulation large vessel occlusion strokeOutcome predictionAcute stroke triageAnterior circulation territoryRadiomic featuresTime of admissionGeisinger Medical CenterLVO stroke patientsReliable clinical informationSignificant differencesAdmission CTAStroke patientsPrognostic informationFavorable outcomeStroke triageTreatment decisionsMedical CenterRadiomics signatureCerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions
Magid-Bernstein J, Girard R, Polster S, Srinath A, Romanos S, Awad IA, Sansing LH. Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circulation Research 2022, 130: 1204-1229. PMID: 35420918, PMCID: PMC10032582, DOI: 10.1161/circresaha.121.319949.Peer-Reviewed Original ResearchConceptsMechanism of injuryIntracerebral hemorrhageUltra-early hemostatic therapyInflammatory brain injuryCurrent treatment strategiesIron-induced injuryAnticoagulant useHemostatic therapyHemorrhagic strokeHypertension managementICH therapySurgical managementHigh morbidityPrimary preventionFunctional outcomeICH managementBrain injuryClinical trialsTreatment strategiesPrognostic biomarkerDevastating formDisease pathobiologyInjuryInvasive surgeryOxidative stressThe Stroke Preclinical Assessment Network: Rationale, Design, Feasibility, and Stage 1 Results
Lyden PD, Bosetti F, Diniz MA, Rogatko A, Koenig JI, Lamb J, Nagarkatti KA, Cabeen RP, Hess DC, Kamat PK, Khan MB, Wood K, Dhandapani K, Arbab AS, Leira EC, Chauhan AK, Dhanesha N, Patel RB, Kumskova M, Thedens D, Morais A, Imai T, Qin T, Ayata C, Boisserand LSB, Herman AL, Beatty HE, Velazquez SE, Diaz-Perez S, Sanganahalli BG, Mihailovic JM, Hyder F, Sansing LH, Koehler RC, Lannon S, Shi Y, Karuppagounder SS, Bibic A, Akhter K, Aronowski J, McCullough LD, Chauhan A, Goh A, Siddiqui S, Sheth K, Matouk C, Cruz C, Zhou J, Dawson V, Dawson T, Liang J, van Zijl P, Zeiler S, Taylor Kimberly W, Erdogan T, Yu L, Mandeville J, Whittier J. The Stroke Preclinical Assessment Network: Rationale, Design, Feasibility, and Stage 1 Results. Stroke 2022, 53: 1802-1812. PMID: 35354299, PMCID: PMC9038686, DOI: 10.1161/strokeaha.121.038047.Peer-Reviewed Original ResearchConceptsPreclinical assessmentStroke treatmentCandidate treatmentMiddle cerebral artery occlusion (MCAO) surgeryClinical stroke trialsSuccessful stroke treatmentInclusion/exclusion criteriaStroke clinical trialsClinical trial designYoung male animalsComorbid diseasesOcclusion surgeryCerebral ischemiaNeurological disabilityComorbid conditionsStroke trialsProtocol adherenceBlinded assessmentSuch therapyClinical trialsClinical studiesExclusion criteriaTrial designAged animalsOutcome assessmentAcute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns
Baker AD, Schwamm LH, Sanborn DY, Furie K, Stretz C, Mac Grory B, Yaghi S, Kleindorfer D, Sucharew H, Mackey J, Walsh K, Flaherty M, Kissela B, Alwell K, Khoury J, Khatri P, Adeoye O, Ferioli S, Woo D, Martini S, La Rosa F, Demel SL, Madsen T, Star M, Coleman E, Slavin S, Jasne A, Mistry EA, Haverbusch M, Merkler AE, Kamel H, Schindler J, Sansing LH, Faridi KF, Sugeng L, Sheth KN, Sharma R. Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns. Stroke 2022, 53: 1883-1891. PMID: 35086361, PMCID: PMC10214981, DOI: 10.1161/strokeaha.121.036706.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionAcute ischemic strokeDepressed left ventricular ejection fractionVentricular ejection fractionSinus rhythmIschemic strokeEjection fractionPooled prevalenceHealth Stroke Severity ScaleSecondary stroke prevention strategiesMultivariable logistic regression modelAntithrombotic treatment regimensHospital-based cohortRetrospective cohort studySecondary stroke preventionStroke prevention strategiesMulti-center cohortStroke Severity ScaleLogistic regression modelsEchocardiographic characteristicsHospitalization dischargeAntiplatelet therapyStroke preventionCardiac thrombusCohort studyBedside detection of intracranial midline shift using portable magnetic resonance imaging
Sheth KN, Yuen MM, Mazurek MH, Cahn BA, Prabhat AM, Salehi S, Shah JT, By S, Welch EB, Sofka M, Sacolick LI, Kim JA, Payabvash S, Falcone GJ, Gilmore EJ, Hwang DY, Matouk C, Gordon-Kundu B, RN AW, Petersen N, Schindler J, Gobeske KT, Sansing LH, Sze G, Rosen MS, Kimberly WT, Kundu P. Bedside detection of intracranial midline shift using portable magnetic resonance imaging. Scientific Reports 2022, 12: 67. PMID: 34996970, PMCID: PMC8742125, DOI: 10.1038/s41598-021-03892-7.Peer-Reviewed Original ResearchConceptsMidline shiftNeuroscience intensive care unitCare measurementYale-New Haven HospitalValuable bedside toolIntensive care unitPoor clinical outcomeBrain-injured patientsMass effectNew Haven HospitalMagnetic resonance imagingClinical outcomesIll patientsCare unitStroke patientsFunctional outcomeBedside toolObservational studyBedside detectionImaging examsPatientsResonance imagingPortable MRIImaging suiteSignificant concordance
2021
International Post Stroke Epilepsy Research Consortium (IPSERC): A consortium to accelerate discoveries in preventing epileptogenesis after stroke
Mishra NK, Engel J, Liebeskind DS, Sharma VK, Hirsch LJ, Kasner SE, French JA, Devinsky O, Friedman A, Dawson J, Quinn TJ, Selim M, de Havenon A, Yasuda CL, Cendes F, Benninger F, Zaveri HP, Burneo JG, Srivastava P, Singh M, Bhatia R, Vishnu VY, Bentes C, Ferro J, Weiss S, Sivaraju A, Kim JA, Galovic M, Gilmore EJ, Pitkänen A, Davis K, Sansing LH, Sheth KN, Paz JT, Singh A, Sheth S, Worrall BB, Grotta JC, Casillas-Espinos PM, Chen Z, Nicolo JP, Yan B, Kwan P, Consortium F. International Post Stroke Epilepsy Research Consortium (IPSERC): A consortium to accelerate discoveries in preventing epileptogenesis after stroke. Epilepsy & Behavior 2021, 127: 108502. PMID: 34968775, DOI: 10.1016/j.yebeh.2021.108502.Peer-Reviewed Original ResearchSimilar admission NIHSS may represent larger tissue-at-risk in patients with right-sided versus left-sided large vessel occlusion
Mak A, Matouk C, Avery EW, Behland J, Frey D, Madai VI, Vajkoczy P, Malhotra A, Karam A, Sanelli P, Falcone GJ, Petersen NH, Sansing L, Sheth KN, Payabvash S. Similar admission NIHSS may represent larger tissue-at-risk in patients with right-sided versus left-sided large vessel occlusion. Journal Of NeuroInterventional Surgery 2021, 14: 985-991. PMID: 34645705, DOI: 10.1136/neurintsurg-2021-017785.Peer-Reviewed Original ResearchConceptsLarge vessel occlusionFinal infarct volumeLarger final infarct volumeWorse discharge outcomesInfarct volumeAdmission NIHSSDischarge outcomesVessel occlusionScale scoreMultivariate analysisAnterior large vessel occlusionLower admission NIHSS scoreHealth Stroke Scale scoreAdmission National InstitutesAdmission stroke severityPoor discharge outcomeStroke Scale scoreLarger infarct volumesAdmission NIHSS scoreRankin Scale scoreVoxel-wise analysisIncomplete reperfusionInfarct distributionOcclusion sideNIHSS scoreThe coronal plane maximum diameter of deep intracerebral hemorrhage predicts functional outcome more accurately than hematoma volume
Haider SP, Qureshi AI, Jain A, Tharmaseelan H, Berson ER, Majidi S, Filippi CG, Mak A, Werring DJ, Acosta JN, Malhotra A, Kim JA, Sansing LH, Falcone G, Sheth K, Payabvash S. The coronal plane maximum diameter of deep intracerebral hemorrhage predicts functional outcome more accurately than hematoma volume. International Journal Of Stroke 2021, 17: 777-784. PMID: 34569877, PMCID: PMC9005571, DOI: 10.1177/17474930211050749.Peer-Reviewed Original ResearchExcess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic
Sharma R, Kuohn LR, Weinberger DM, Warren JL, Sansing LH, Jasne A, Falcone G, Dhand A, Sheth KN. Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic. Stroke 2021, 52: 563-572. PMID: 33430638, PMCID: PMC7834664, DOI: 10.1161/strokeaha.120.031975.Peer-Reviewed Original ResearchConceptsEmergency medical servicesCerebrovascular deathCOVID-19 deathsCerebrovascular mortalityCOVID-19 pandemicStroke-related deathCoronavirus disease 2019 (COVID-19) pandemicFirst COVID-19 deathDisease 2019 pandemicPublic health measuresHealth Statistics dataPoisson regression modelsCumulative COVID-19 deathsAcute strokeStroke deathsVascular pathologyEMS callsMedical careHealth measuresNew York CityMortalityDeathMedical servicesWeeksRegression analysis
2020
Plasma neurofilament light predicts mortality in patients with stroke
Gendron TF, Badi MK, Heckman MG, Jansen-West KR, Vilanilam GK, Johnson PW, Burch AR, Walton RL, Ross OA, Brott TG, Miller TM, Berry JD, Nicholson KA, Wszolek ZK, Oskarsson BE, Sheth KN, Sansing LH, Falcone GJ, Cucchiara BL, Meschia JF, Petrucelli L. Plasma neurofilament light predicts mortality in patients with stroke. Science Translational Medicine 2020, 12 PMID: 33177179, PMCID: PMC9534269, DOI: 10.1126/scitranslmed.aay1913.Peer-Reviewed Original ResearchConceptsBlood neurofilament lightNeurofilament lightStroke typeNeuroaxonal injuryHigher NfL concentrationsMini-Mental State ExaminationStroke brain injuryAcute cerebral infarctionModified Rankin ScaleEarly ischemic injuryNontraumatic intracerebral hemorrhageNIH Stroke ScaleBrain tissue damagePlasma neurofilament lightIntracranial hemorrhage volumeClinical trial efficiencyBlood biomarker studiesStroke therapeuticsCause mortalityStroke ScaleCerebral infarctionRankin ScaleFunctional disabilityIntracerebral hemorrhageIschemic injuryEffects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke
Al-Dasuqi K, Payabvash S, Torres-Flores GA, Strander SM, Nguyen CK, Peshwe KU, Kodali S, Silverman A, Malhotra A, Johnson MH, Matouk CC, Schindler JL, Sansing LH, Falcone GJ, Sheth KN, Petersen NH. Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke. Stroke 2020, 51: e193-e202. PMID: 32781941, PMCID: PMC7484023, DOI: 10.1161/strokeaha.120.029892.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overArterial Occlusive DiseasesCerebral InfarctionCohort StudiesCollateral CirculationComputed Tomography AngiographyEndovascular ProceduresFemaleHumansInfarction, Middle Cerebral ArteryLinear ModelsMagnetic Resonance AngiographyMaleMiddle AgedReperfusionRetrospective StudiesStrokeThrombectomyTreatment OutcomeWhite MatterConceptsLarge vessel occlusion strokeFinal infarct volumeCollateral statusPoor collateral statusFavorable outcomeInfarct distributionInfarct volumeReperfusion successIndependent predictorsOcclusion strokeInternal capsuleAnterior circulation large vessel occlusion ischemic strokeLarge vessel occlusion ischemic strokeDeep white matter tractsBaseline collateral statusBorder-zone infarctionEarly favorable outcomeEarly functional outcomesRankin Scale scoreCohort of patientsDegree of reperfusionLarge vessel occlusionComputed tomography angiographyDeep white matterMagnetic resonance imagingStroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitalsPreserving stroke care during the COVID-19 pandemic: Potential issues and solutions.
Leira EC, Russman AN, Biller J, Brown DL, Bushnell CD, Caso V, Chamorro A, Creutzfeldt CJ, Cruz-Flores S, Elkind MSV, Fayad P, Froehler MT, Goldstein LB, Gonzales NR, Kaskie B, Khatri P, Livesay S, Liebeskind DS, Majersik JJ, Moheet AM, Romano JG, Sanossian N, Sansing LH, Silver B, Simpkins AN, Smith W, Tirschwell DL, Wang DZ, Yavagal DR, Worrall BB. Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions. Neurology 2020, 95: 124-133. PMID: 32385186, PMCID: PMC7455350, DOI: 10.1212/wnl.0000000000009713.Peer-Reviewed Original ResearchMeSH KeywordsBetacoronavirusBiomedical ResearchCoronavirus InfectionsCOVID-19Delivery of Health CareEthics, MedicalHealth Care RationingHealth ResourcesHealth Services AccessibilityHealth Services Needs and DemandHospital Bed CapacityHumansIntensive Care UnitsNeurologyPandemicsPneumonia, ViralQuality of Health CareSARS-CoV-2StrokeTelemedicine