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Abstract
Coronavirus disease 2019 (COVID-19) resulted in a worldwide pandemic that at the time of this writing has caused over 400,000 deaths within the United States. During the pandemic surge in New York City, NY, a number of military Medical Corps (MC) and Nurse Corps (NC) providers were mobilized in direct support of critical care capabilities through expansion intensive care units. In the course of the deployment, high rates of neurological-related manifestations associated with COVID-19 infection were directly observed by our military provider teams which will be described and supporting literature highlighted.This is organic information absorbed in real time during the early stages of the pandemic in New York City.The neurological manifestations of COVID-19 varied in presentation and severity. Cerebral vascular injuries documented included strokes, iatrogenic intraparenchymal hemorrhage, hypoxia-related changes and sequelae, as well as acquired diseases secondary to delayed treatment of other primary neurologic disease states. Hypercoagulable and inflammatory markers (d-dimer, C-reactive protein, etc) were commonly elevated, and anticoagulation became a key factor in disease treatment and to help mitigate the downstream neurologic sequelae associated with this disease.Here we present these initial findings to lay the groundwork for more robust clinical studies moving forward.
Highlights
Triservice military medical teams were rapidly mobilized to provide aid and services during the coronavirus disease 2019 (COVID-19) pandemic surge in New York City, NY, of 2020. These military medical assets consisted of physicians, nurses, and associated healthcare support staff who were assigned to platforms including the Navy Medicine Support Team (NMST), the Army Urban Augmentation Medical Task Forces (UAMTFs), and Air Force Reservists which were integrated into various New York City (NYC) civilian hospitals
Multivariable regression analysis showed increased odds of in-hospital death associated with older age, higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p=0.0033), and d-dimer measurements greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission
Familiarity and integration of the latest stroke intervention criteria combined with the best possible neurologic examination are critical given the many manifestations that this virus has on the human body
Summary
Triservice military medical teams were rapidly mobilized to provide aid and services during the coronavirus disease 2019 (COVID-19) pandemic surge in New York City, NY, of 2020. A 33-year-old patient illustrated in this publication delayed seeking care within the mechanical intervention window secondary to concerns of COVID-19 risk if she were to present to a medical center for evaluation and/or treatment. A 39-yearold male with no significant past medical history presented to the emergency room suffering from hemiplegia following a night of excessive alcohol intake (see radiographic images of Figure 1) This particular patient lived in a highly burdened community where widespread COVID-19 infection was noted, and he directly had several sick contacts in his home setting. A 47-year-old female presented to our ICU as a transferred from the ER with “the worst headache of her life” She delayed going to a hospital for six days since her headache onset despite having intermittent hemiplegia and confusion due to concerns of COVID-19 exposure risk. FIGURE 2: 47-year-old female with ruptured L posterior communicating artery aneurysm
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