Stroke & Neurocritical Care

As this issue of Practical Neurology goes to press, we look back on 2020—a year to remember for none of the right reasons. As much we would like the inherent challenges of 2020 to be over, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is here to stay. Learning to navigate the clinical aspects of the coronavirus disease 2019 (COVID-19) spectrum and its effects on our patients will be a key part of acute care neurology for some time. In this issue, an enterprising team of neurocritical care professionals, collaborating with neurology subspecialists, provides a broad overview of the wide range of clinical aspects affecting neurocritical care in the COVID-19 era.

Considering SARs-CoV-2 is a neurotropic virus, the neurology community held its breath as the pandemic evolved, based on prior experience with coronavirus and neurologic manifestations. Drs. Mainali and Darsie provide a thorough overview in Neurologic Manifestations & Associations of COVID-19, covering the wide spectrum of neurologic symptoms observed. Next, in COVID-19 & Stroke, Dr. Nobleza and colleagues analyze the effects of the COVID-19 pandemic on stroke presentations and systems of care as well as unique cerebrovascular complications associated with SARS-CoV-2 itself.

Drs. Tucker and Swor then review Ethical Neurologic Care During a Pandemic, covering arduous topics, such as resource allocation, in a system that is implicitly and inherently biased against people with neurologic disabilities. While emphasizing the duty of medical providers to ensure high quality care for neurologic disorders, the roles patients and surrogates can play to help enhance delivery of care is also addressed, as is the effect of the pandemic on the health of medical professionals.

Among the resources affected by the pandemic, are various noninvasive neuromonitoring modalities to supplement the challenges of Neurologic Assessment & Neuromonitoring in the COVID-19 Pandemic, elegantly covered by Drs. Sisniega and Reynolds.

In Neuroimmunomodulation & COVID-19, Drs. Venegas-Borsellino, Mehta, and Rogers examine the inflammatory response to SARS-CoV-2 infection and cover key recommendations for our patients using immunosuppressive and immunomodulatory therapies for neurologic diseases. Similarly, in Neuromuscular Medicine & COVID-19, Drs. Jeanneret, Rubinos, and Desai provide a thorough review of neuromuscular complications of SARs-CoV-2 infection and treatment and also cover strategies to address the unique challenges for those who have neuromuscular diseases not directly affected by COVID-19.

A silver lining in this dark year has been the agility of our systems in adopting telemedicine and addressing how to jump through required regulatory hoops in a short period of time. There is significant value in investing in a sustainable telemedicine platform—afforded urgency by the pandemic—with an impact that will last long after the pandemic dissipates to provide access to underserved areas with potential to change the landscape of health care disparities. In Telestroke & Telecritical Care, Drs. Dangayach, Sharma, and Moheet give a thorough review of how telestroke and telecritical care can be beneficial in maintaining high quality care given the inherent challenges of exposure during this pandemic.

While it was a pleasure to serve as Guest Medical Editor for this issue of Practical Neurology, I was also humbled by the dedication of this team in completing the issue on time while being frontline providers in their intensive care units. I am also grateful for the help and perseverance of the editorial team, who went above and beyond to make this issue possible. I hope these articles help our neurology community navigate the challenges posed by this unique pandemic in their clinical practice of acute care neurology. As this issue is published, I sincerely hope we are well on our way to getting our grip on this pandemic and making 2021 a year worth remembering as the year we conquer a global crisis. Godspeed.