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Martin S Gizzi1,2, Ryan J Mason2, Andrew Amaranto2,3
1aDepartment of Neurology, Hackensack University Medical Center, Hackensack, New Jersey, USA.
Case Reports in Neurology
|February 24, 2023
Summary
The COVID-19 pandemic created barriers to timely stroke care due to mask-wearing and isolation protocols. Routine cranial nerve assessment in emergency departments is crucial for non-COVID patients.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- The COVID-19 pandemic significantly altered emergency department (ED) operations globally.
- Universal masking and isolation protocols presented challenges to routine patient assessment and timely care, particularly for conditions like stroke.
Observation:
- A patient presented with non-specific symptoms including weakness and cough, with initial assessment delayed.
- Facial asymmetry and gait disturbance were noted only after a detailed neurological examination, prompted by the patient's daughter's concerns.
- The delay in recognizing stroke symptoms was exacerbated by the need to consider COVID-19 and the constraints of mask-wearing.
Findings:
- The patient was diagnosed with an acute infarct at the right thalamocapsular junction, indicating a delayed stroke diagnosis.
- The delay in diagnosis and treatment initiation was approximately 50 minutes from initial ED presentation.
- The case underscores how pandemic-related protocols can inadvertently impede the identification of critical non-COVID conditions.
Implications:
- Universal masking policies should not preclude essential components of neurological examination, such as assessing cranial nerve function.
- Emergency medicine providers must remain vigilant for stroke symptoms despite the challenges posed by infectious disease protocols.
- Ensuring comprehensive patient evaluations is vital to prevent adverse outcomes in non-COVID patients during public health crises.
