Publications by authors named "Aaron Rothstein"

12 Publications

  • Page 1 of 1

Global Impact of COVID-19 on Stroke Care and Intravenous Thrombolysis.

Neurology 2021 Mar 25. Epub 2021 Mar 25.

Department of Neurology, University of North Carolina at Chapel Hill, North Carolina, USA.

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods.

Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases.

Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI, -11.7 to - 11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI, -13.8 to -12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI, -13.7 to -10.3, p=0.001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions.

Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
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http://dx.doi.org/10.1212/WNL.0000000000011885DOI Listing
March 2021

Response by Rothstein and Cucchiara to Letter Regarding Article, "Acute Cerebrovascular Events in Hospitalized COVID-19 Patients".

Stroke 2021 01 25;52(2):e72. Epub 2021 Jan 25.

Department of Neurology, University of Pennsylvania, Philadelphia.

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http://dx.doi.org/10.1161/STROKEAHA.120.032902DOI Listing
January 2021

Venous Duplex Ultrasound Surveillance in the Neurosurgical Population: A Single-Center Quality Improvement Initiative.

World Neurosurg 2020 Dec 3;144:e80-e86. Epub 2020 Aug 3.

Department of Neurosurgery, NYU Langone Health, New York, New York, USA. Electronic address:

Background: Venous thromboembolism (VTE) represents a significant source of morbidity and mortality in the inpatient population and is considered a leading preventable cause of death among inpatients. Neurosurgical inpatients are of particular interest because of the greater rates of immobility, steroid use, and potential consequences of postoperative hemorrhage. A consensus protocol for VTE screening in this population has not yet been developed, and institutional protocols vary widely.

Methods: We performed a retrospective review of lower extremity venous duplex ultrasonography (VDUS) usage at our institution and applied this information to the development of a neurosurgery department protocol, with consideration of high-risk patient risk factors and indications for VDUS ordering. We then implemented this protocol, which consisted of preoperative screening of patients at high risk of VTE and limited postoperative surveillance, for a 6-month period and compared VDUS usage and VTE occurrence.

Results: Preoperative VDUS screening before nonemergent neurosurgical procedures in high-risk patients with active cancer, an inability to ambulate, or a history of deep vein thrombosis (DVT) identified proximal DVTs that were then treated. Postoperative routine surveillance VDUS scans only diagnosed incidental isolated calf DVT for which no clinically relevant sequelae occurred. Overall, postoperative surveillance VDUS usage decreased significantly (66.9% vs. 13.5%; P = 0.001).

Conclusions: Our findings lend support to preoperative screening of high-risk patients and suggest that routine postoperative VDUS surveillance of asymptomatic patients is unnecessary.
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http://dx.doi.org/10.1016/j.wneu.2020.07.207DOI Listing
December 2020

Acute Cerebrovascular Events in Hospitalized COVID-19 Patients.

Stroke 2020 09 20;51(9):e219-e222. Epub 2020 Jul 20.

Department of Neurology, University of Pennsylvania, Philadelphia.

Background And Purpose: Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States.

Methods: We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals.

Results: We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation.

Conclusions: We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.
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http://dx.doi.org/10.1161/STROKEAHA.120.030995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386677PMC
September 2020

Pearls & Oy-sters: Bilateral globus pallidus lesions in a patient with COVID-19.

Neurology 2020 09 25;95(10):454-457. Epub 2020 Jun 25.

From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA.

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http://dx.doi.org/10.1212/WNL.0000000000010157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538218PMC
September 2020

Intracranial vessel wall MR imaging of an intradural vertebral artery dissection.

Clin Imaging 2020 Dec 17;68:108-110. Epub 2020 Jun 17.

University of Pennsylvania Health Systems (UPHS), 3400 Spruce Street, Philadelphia, PA 19104, USA.

Diagnosis of intracranial arterial dissections can be challenging due to the wide spectrum of imaging presentations. High-resolution vessel wall MR imaging can be a useful adjunct to conventional lumen-based imaging techniques for diagnosing arterial dissections. We present a case of a 37-year-old male with a history of a Wolff-Parkinson-White syndrome presenting with acute onset of nausea, vertigo, and left body hemisensory loss of pain and temperature. A conventional brain MRI identified an acute infarct in the right lateral medulla, concordant with clinical symptoms of Wallenberg syndrome. CT angiogram of the head and neck showed lack of opacification of the right intradural vertebral artery. Intracranial vessel wall MR imaging showed findings suggestive of an intimal dissection flap with both intramural and intraluminal thrombus. Intracranial vessel wall MR imaging can provide complementary information to conventional lumen-based imaging to diagnose a vertebral dissection.
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http://dx.doi.org/10.1016/j.clinimag.2020.06.024DOI Listing
December 2020

Clinical Reasoning: A 41-year-old man with thunderclap headache.

Neurology 2018 07;91(1):e87-e91

From the Departments of Neurology (S. Grossman, A.R., J.C., L.G., S. Galetta) and Psychiatry (L.G.), New York University, New York.

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http://dx.doi.org/10.1212/WNL.0000000000005738DOI Listing
July 2018

Right Brain: Withholding treatment from a child with an epileptic encephalomyopathy.

Neurology 2018 05;90(18):857-859

From the Department of Neurology, NYU Langone Medical Center, New York.

The case of Charlie Gard, an infant who was hospitalized in England due to a mitochondrial DNA depletion syndrome that led to an epileptic encephalomyopathy, was highly publicized. Though Charlie's parents lobbied for him to receive experimental nucleoside replacement therapy as a desperate effort to save him, this request was denied, and after a lengthy legal battle, he died in late July 2017. We discuss the ethical considerations and consequences of this case.
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http://dx.doi.org/10.1212/WNL.0000000000005416DOI Listing
May 2018

Results of a quality improvement initiative reassessing an institutional lumbar drain infection prevention protocol.

J Neurosurg Spine 2018 07 27;29(1):54-58. Epub 2018 Apr 27.

2Neurosurgery, NYU Langone Medical Center, New York, New York.

OBJECTIVE The objective of this study was to determine the effects of a quality improvement initiative in which daily antibiotics and daily sampling of cerebrospinal fluid (CSF) were discontinued for patients with lumbar drains. METHODS The frequency of surgical site infections (SSIs), antibiotic-related complications (development of Clostridium difficile infection [CDI] and growth of resistant bacteria), and cost for patients with lumbar drains were compared during 3 periods: 1) prolonged prophylactic systemic antibiotics (PPSA) until the time of drain removal and daily CSF sampling (September 2013-2014), 2) PPSA and CSF sampling once after placement then as needed (January 2015-2016), and 3) antibiotics only during placement of the lumbar drain and CSF sampling once after placement then as needed (April 2016-2017). RESULTS Thirty-nine patients were identified in period 1, 53 patients in period 2, and 39 patients in period 3. There was no change in the frequency of SSI after discontinuation of routine CSF testing or PPSA (0% in period 1, 2% in period 2, and 0% in period 3). In periods 1 and 2, 3 patients developed infections due to resistant organisms and 2 patients had CDI. In period 3, 1 patient had an infection due to a resistant organism. The median cost of CSF tests per patient was $100.68 (interquartile range [IQR] $100.68-$134.24) for patients in period 1 and $33.56 (IQR $33.56-$33.56) in periods 2 and 3 (p < 0.001). The median cost of antibiotics per patient was $26.32 (IQR $26.32-$30.65) in periods 1 and 2 and $3.29 ($3.29-$3.29) in period 3 (p < 0.001). The cost associated with growth of resistant bacteria and CDI was $91,291 in periods 1 and 2 and $25,573 in period 3. CONCLUSIONS After discontinuing daily antibiotics and daily CSF sampling for patients with lumbar drains, the frequency of SSI was unchanged and the frequency of antibiotic-related complications decreased.
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http://dx.doi.org/10.3171/2017.11.SPINE171023DOI Listing
July 2018

The Challenges of Discussing "Longshot" and "Fantasy" Treatments.

Am J Bioeth 2018 01;18(1):27-29

a NYU Langone Medical Center.

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http://dx.doi.org/10.1080/15265161.2017.1401168DOI Listing
January 2018

Blastomyces gilchristii as Cause of Fatal Acute Respiratory Distress Syndrome.

Emerg Infect Dis 2016 Feb;22(2):306-8

Since the 2013 description of Blastomyces gilchristii, research describing the virulence or clinical outcome of B. gilchristii infection has been lacking. We report molecular evidence of B. gilchristii as an etiologic agent of fatal acute respiratory distress syndrome. B. gilchristii infection was confirmed by PCR and sequence analysis.
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http://dx.doi.org/10.3201/eid2202.151183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734522PMC
February 2016