R4VaD is a large, multicentre, longitudinal, inclusive study in patients presenting with stroke to UK Stroke Centres. It uses standardised proportionate ascertainment methods to assess cognition, physical function, neuropsychiatric complications and dependence to at least two years after stroke. R4VaD is a Priority Programme funded by the Stroke Association, BHF, Alzheimer’s Society, and MRC Dementia Platform UK.

R4VaD is a prospective observational, longitudinal inception cohort with central follow-up and nested sub-studies in major UK stroke centres representing geographic and socioeconomic diversity. R4VaD had recruited 1273 patients in 53 centers over 18 months to mid-March 2020.

R4VaD has approval to continue recruiting during the COVID-19 pandemic. During the early stages of the COVID-19 outbreak, R4VaD had already identified adverse impacts of COVID-19 and social distancing measures on patients up to 12 months after stroke, including high levels of anxiety and major difficulties with social support during introduction of the UK social distancing measures.

By continuing to recruit through the pandemic, using a streamlined data collection form to reduce burden on patients and researchers, R4VaD aims to compare data collected before, during and after the pandemic, using existing funded infrastructure. It will be one of the few opportunities to obtain objective data on COVID-19 and stroke, including at late stages after stroke.  COVID-19 may be a risk factor for ischaemic stroke, may influence the severity and prognosis of those who present with stroke, and together with the social distancing measures, may affect the long-term recovery and life after stroke.  These effects are unknown.

R4VaD encourages co-enrolment and uses simplified data collection processes to maximise the contribution to, while minimising the burden of, the research.

If you would like any more information about R4VaD, please contact us on r4vad@ed.ac.uk.

This service evaluation of the impact of COVID-19 on stroke is a collaboration between stroke services across the UK and we are keen for more centres to join.  Data are collected on the clinical, laboratory and imaging features of patients presenting with stroke during the pandemic, using a short case report form.  Patients with and without COVID-19 infection are included and these two groups are compared in a case-control design.  Because we have centres involved right across the UK we are able to compare centres seeing large numbers of COVID-19-positive patients with those who currently see relatively few.  The spectrum of stroke cases that we see is changing and we will use the data to disentangle the direct effects of the virus from the effects of social distancing, a sudden change in public behaviour which also appears to have an impact on stroke presentation.  The data will guide better predictions about the consequences for our stroke services as the pandemic evolves.  In addition we will learn more about the pathophysiology of stroke in the context of COVID-19 infection, including the apparent hypercoagulable state which is seen in some patients and may require a specific management strategy.  The faster we can collect data, the faster we will all be able to learn from it, so please do join our effort if you can.  Our goal is to analyse data in real time and share results with all participating centres as quickly as possible.  Approval is gained through your own stroke service leadership and your clinical governance department rather than the Health Research Authority, as the study only uses routine data collected from the clinical record.  Many centres have non-clinical staff whose normal work has been severely curtailed by the pandemic and who can support this important effort.  If you think that your centre can help, please contact us as soon as possible on uclh.seticos@nhs.net or richard.perry2@nhs.net.

Emerging information about the presentation, prognosis, prevention, and treatment of COVID-19 is constantly evolving, so you may wish to refer to collections of articles and other resources from some of the relevant journals or search for relevant articles via PubMed

The Lancet

 – The Lancet article: Challenges for the female academic during the COVID-19 pandemic

New England Journal of Medicine


 – BMJ Article – Covid-19: a remote assessment in primary care


Publication topics:

Click on the topic below to be directed to the relevant section of the page.

General Neurological manifestations of COVID-19

COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI FeaturesRadiology 2020 Mar 31 [Online ahead of print] Neo Poyiadji, Gassan Shahin, Daniel Noujaim, Michael Stone, Suresh Patel, Brent Griffith.

COVID-19 presenting with ophthalmoparesis from cranial nerve palsy; Marc DinkinVirginia GaoJoshua KahanSarah BobkerMarialaura SimonettoPaul WechslerJasmin HarpeChristine GreerGregory MintsGayle SalamaApostolos John TsiourisDana Leifer

Rapid implementation of virtual neurology in response to the COVID-19 pandemic; Scott N. GrossmanSteven C. HanLaura J. BalcerArielle KurzweilHarold WeinbergSteven L. GalettaNeil A. Busis

Neurologic Features in Severe SARS-CoV-2 Infection [published online ahead of print, 2020 Apr 15]. N Engl J Med. 2020;10.1056/NEJMc2008597. doi:10.1056/NEJMc2008597 Helms J, Kremer S, Merdji H, et al.

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, ChinaMao L, Jin H, Wang M, et al. JAMA Neurol. Published online April 10, 2020. doi:10.1001/jamaneurol.2020.1127

Neurologic complications of coronavirus infections; Nath A.; Neurology May 2020, 94 (19) 809-810; DOI: 10.1212/WNL.0000000000009455

The Neurology and Neuropsychiatry of COVID-19; Matt Butler, Cameron Watson, Mark Ellul, Tom Pollak, Benedict Michael and Tim Nicholson; Journal of Neurology, Neuroscience and Psychiatry.

Early postmortem brain MRI findings in COVID-19 non-survivors; Tim CoolenValentina LolliNiloufar SadeghiAntonin RovaïNicola TrottaFabio Silvio TacconeJacques CreteurSophie HenrardJean-Christophe GoffardOlivier De WitteGilles NaeijeSerge GoldmanXavier De Tiège

Neurochemical evidence of astrocytic and neuronal injury commonly found in COVID-19; Nelly KanbergNicholas J. AshtonLars-Magnus AnderssonAylin YilmazMagnus LindhStaffan NilssonRichard W PriceKaj BlennowHenrik ZetterbergMagnus Gisslén

New onset neurologic events in people with COVID-19 infection in three regions in China; Weixi Xiong, Jie MuJian Guo, Lu Lu, Dan Liu, Jianfei LuoNian Li, Jing LiuDan YangHui GaoYingying ZhangMintao LinSisi ShenHesheng ZhangLei ChenGang WangFengming LuoWeimin LiShengli ChenLi HeJosemir W. SanderDong Zhou

Incidence and case fatality rate of COVID-19 in patients with active epilepsy; Pablo Cabezudo-GarcíaNicolás Lundahl Ciano-Petersen, Natalia Mena-VázquezGracia Pons-PonsMaría Victoria Castro-SánchezPedro J. Serrano-Castro

Neurological and neuropsychiatric complications of
COVID-19 in 153 patients: a UK-wide surveillance study
Aravinthan Varatharaj, Naomi Thomas, Mark A Ellul, Nicholas W S Davies, Thomas A Pollak, Elizabeth L Tenorio, Mustafa Sultan, Ava Easton, Gerome Breen, Michael Zandi, Jonathan P Coles, Hadi Manji, Rustam Al-Shahi Salman, David K Menon, Timothy R Nicholson, Laura A Benjamin, Alan Carson, Craig Smith, Martin R Turner, Tom Solomon, Rachel Kneen, Sarah L Pett, Ian Galea*, Rhys H Thomas*, Benedict D Michael*, onbehalf of the CoroNerve Study Group†


Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm; Matthew S. Smith, MD; Jordan Bonomo, MD; William A. Knight IV, MD; Charles J. Prestigiacomo, MD; Christopher T. Richards, MD, MS; Evan Ramser, DO; Opeolu Adeoye, MD; Stuart Bertsch, MD; Peyman Shirani, MD; Achala Vagal, MD; Carl J. Fichtenbaum, MD; Anne Housholder, MD, MPH; Pooja Khatri, MD; Dawn O. Kleindorfer, MD; Joseph P. Broderick, MD; Aaron W. Grossman , MD, PhD
American Heart Association Journal, 2020; pg1-8; doi:10.1161/STROKEAHA.120.029863

Mechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams A Guidance Statement From the Society of Vascular and Interventional Neurology; Thanh N. Nguyen , MD, FRCPc; Mohamad Abdalkader, MD; Tudor G. Jovin, MD; Raul G. Nogueira, MD; Ashutosh P. Jadhav, MD; Diogo C. Haussen, MD; Ameer E. Hassan, DO; Roberta Novakovic, MD; Sunil A. Sheth, MD; Santiago Ortega-Gutierrez, MD, MSc; Peter D. Panagos, MD; Steve M. Cordina, MD; Italo Linfante, MD; Ossama Yassin Mansour, MD, PhD; Amer M. Malik, MD, MBA; Sandra Narayanan, MD; Hesham E. Masoud, MD;
Sherry Hsiang-Yi Chou, MD; Rakesh Khatri, MD; Vallabh Janardhan, MD; Dileep R. Yavagal, MD; Osama O. Zaidat, MD; David M. Greer, MD; David S. Liebeskind, MD
American Heart Association Journal, 2020; pg1-6;doi:10.1161/STROKEAHA.120.030100

CSC Expert Consensus on Principles of Clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 Epidemic; Running Title: Han et al.; Consensus on Managing CVD during COVID-19 Epidemic; Yaling Han, MD, FACC, FAHA, Chair; Hesong Zeng, MD, co-chair; Hong Jiang, MD, FACC,
co-chair; Yuejin Yang, MD, FACC, co-chair; Zuyi Yuan, MD, FACC, co-chair; Xiang Cheng,
MD, FACC; Zhicheng Jing, MD; Bin Liu, MD, FACC; Jiyan Chen, MD, FACC; Shaoping
Nie, MD, FACC; Jianhua Zhu, MD, FACC; Fei Li, BN; Changsheng Ma, MD, FACC
American Heart Association Journal, 2020; pg1-21; doi:10.1161/CIRCULATIONAHA.120.047011

Society of Neuro Interventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of covid-19; Justin F Fraser, Adam S Arthur, Michael Chen, Michael Levitt, J Mocco,
Felipe C Albuquerque, Sameer A Ansari, Guilherme Dabus, Mahesh V Jayaraman,
William J Mack, James Milburn, Maxim Mokin , Sandra Narayanan,
Ajit S Puri, Adnan H Siddiqui , Jenny P Tsai, Richard P Klucznik

Fraser JF, et al. J NeuroIntervent Surg 2020; pg1–3. doi:10.1136/neurintsurg-2020-016098

Neurointervention for emergent large vessel occlusion during the covid-19 pandemic; David Fiorella , Kyle M Fargen , Thabele M Leslie-Mazwi, Michael Levitt, Stephen Probst, Sergio Bergese, Joshua A Hirsch , Felipe C Albuquerque

Fiorella D, et al. J NeuroIntervent Surg; 2020 Vol 0; pg 1-3

Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement from Society for Neuroscience in Anesthesiology & Critical Care (SNACC)

Journal of Neurosurgical Anesthesiology; Publish Ahead of Print; DOI:10.1097/ANA.0000000000000688

European Society of Minimally Invasive Neurological Therapy (ESMINT) recommendations for optimal interventional neurovascular management in the covid-19 era. Aggour M, White P, Kulcsar Z, Fiehler J, Brouwer P.  JNIS 2020.

Mechanisms of disease

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Ischemic Stroke; Eduard Valdes Valderrama; Kelley Humbert; Aaron Lord; Jennifer Frontera; Shadi Yaghi

American Heart Association Journal, 2020;
DOI: 10.1161/STROKEAHA.120.030153

Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic MechanismsACS Chemical Neuroscience 2020 11 (7), 995-998 Abdul Mannan Baig, Areeba Khaleeq, Usman Ali, and Hira Syeda.

Neuropathological features of COVID-19. NEJM. 2020 Jun 12 doi; Solomon IH, Normandin E, Bhattacharyya S, Mukerji SS, Keller K, Ali AS, Adams G, Hornick JL, Padera Jr RF, Sabeti P.

Practice guidelines and recommendations

Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke & Vascular Neurology 2020;0. doi:10.1136/svn-2020-000382 Jin H, Hong C, Chen S, et al.

Challenges and Potential Solutions of Stroke Care During the Coronavirus Disease 2019 (COVID-19) Outbreak. Stroke; 51(5):1356-1357 Zhao J, Rudd A, Liu R.

Protected Code Stroke: Hyperacute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic.Khosravani H, Rajendram P, Notario L, Chapman MG, Menon BK.  Stroke 2020 Apr 1:STROKEAHA120029838.

Temporary Emergency Guidance to US Stroke Centers During the COVID-19 Pandemic On Behalf of the AHA/ASA Stroke Council Leadership.

Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Jin H, Hong C, Chen S, et al. Stroke & Vascular Neurology 2020;0. doi:10.1136/

Early Lessons From World War COVID; Sunil A. Sheth, Tzu-Ching Wu, Anjail Sharrief, Christy Ankrom, James C. Grotta, Marc Fisher, Sean I. Savitz;

Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic; Mayank GoyalJohanna M. OspelAndrew M. SoutherlandCharles WiraSepideh Amin-HanjaniJustin F. FraserPeter Panagosand on behalf of the AHA/ASA Stroke Council Science Subcommittees: Emergency Neurovascular Care (ENCC), the Telestroke and the Neurovascular Intervention Committees

Face Coverings, Aerosol Dispersion and Mitigation of Virus Transmission Risk; I. M. Viola, B. Peterson, G. Pisetta, G. Pavar, H. Akhtar, F. Menoloascina, E. Mangano, K. E. Dunn, R. Gabl, A. Nila, E. Molinari, C. Cummins, G. Thompson , C. M. McDougall, T. Y. M. Lo, F. C. Denison, P. Digard 10, O. Malik,  M. J. G. Dunn, F. V. Mehendale

Clinical stroke manifestations and characteristics

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol Published online April 10, 2020. doi:10.1001/jamaneurol.2020.1127 Mao L, Jin H, Wang M, et al.

Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of published literature. International Journal of Stroke. Aggarwal, G., Lippi, G., & Michael Henry, B. (2020).

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med 2020;382(17):e38. doi: 10.1056/NEJMc2007575 Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, Chen H, Ding X, Zhao H, Zhang H, Wang C, Zhao J, Sun X, Tian R, Wu W, Wu D, Ma J, Chen Y, Zhang D, Xie J, Yan X, Zhou X, Liu Z, Wang J, Du B, Qin Y, Gao P, Qin X, Xu Y, Zhang W, Li T, Zhang F, Zhao Y, Li Y, Zhang S.

Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med 2020 Apr 28. doi: 10.1056/NEJMc2009787 Oxley TJ et al.

Characteristics of ischaemic stroke associated with COVID-19 Rahma Beyrouti, Matthew E Adams,Laura Benjamin, Hannah Cohen,Simon F Farmer,Yee Yen Goh,Fiona Humphries,Hans Rolf Jäger, Nicholas A Losseff, Richard J Perry,Sachit Shah,Robert J Simister,David Turner, Arvind Chandratheva,David J Werring

Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study. Yanan Li, Mengdie Wang, Yifan Zhou, Jiang Chang, Ying Xian, Ling Mao, Candong Hong, Shengcai Chen, Yong Wang, Hailing Wang, Man Li, Huijuan Jin, Bo Hu.

SARS2-CoV-2 and Stroke in a New York Healthcare System; Shadi Yaghi, Koto Ishida, Jose Torres, Brian Mac Grory, Eytan Raz, Kelley Humbert, Nils Henninger, Tushar Trivedi, Kaitlyn Lillemoe, Shazia Alam, Matthew Sanger, Sun Kim, Erica Scher, Seena Dehkharghani, Michael Wachs, Omar Tanweer, Frank Volpicelli, Brian Bosworth, Aaron Lord, Jennifer Frontera

Improving Stroke Care in Times of the COVID-19 Pandemic Through Simulation; Martin W. Kurz, Johanna Maria Ospel, Kathinka Daehli Kurz, Mayank Goyal

Clinical Characteristics and Outcomes of COVID-19 Patients With a History of Stroke in Wuhan, China. Stroke. 2020; Chuan Qin, Luoqi Zhou, Ziwei Hu, Sheng Yang, Shuoqi Zhang, Man Chen, Haihan Yu, Dai-Shi Tian, Wei Wang.

Ischemic Stroke Epidemiology During the COVID-19 Pandemic; Georgios Tsivgoulis, Aristeidis H. Katsanos, Raffaele Ornello and Simona Sacco; Stroke, Vol. 51, No. 7 (7): 1924-1926. DOI: 10.1161/STROKEAHA.120.030791

Clinical Characteristics and Outcomes of COVID-19 Patients With a History of Stroke in Wuhan, China; Chuan Qin, Luoqi Zhou, Ziwei Hu, Sheng Yang, Shuoqi Zhang, Man Chen, Haihan Yu, Dai-Shi Tian and Wei Wang; Stroke, Vol. 51, No. 7 (7): 2219-2223. DOI: 10.1161/STROKEAHA.120.030365

Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza; Alexander E. MerklerNeal S. ParikhSaad Mir; et al

COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke; John W. Liang, Alexandra S. Reynolds, Kaitlin Reilly, Cappi Lay, Christopher P. Kellner, Tomoyoshi Shigematsu, Jeffrey Gilligan, Shahram Majidi, Fawaz Al-Mufti, Joshua B. Bederson, et al.

Impact on stroke services

Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions; Jing Zhao, Hang L, David Kung, Marc Fisher, Ying Shen, Renyu Liu

Delays in Stroke Onset to Hospital Arrival Time During COVID-19; Kay-Cheong Teo, William C.Y. Leung, Yuen-Kwun Wong, Roxanna K.C. Liu, Anna H.Y. Chan, Olivia M.Y. Choi, Wing-Man Kwok, Kung-Ki Leung, Man-Yu Tse, Raymond T.F. Cheung, Anderson Chun-On Tsang, Kui Kai Lau

Break in the Stroke Chain of Survival Due to COVID-19. Stroke. 2020; Joan Montaner, Ana Barragán-Prieto, Soledad Pérez-Sánchez, Irene Escudero-Martínez, Francisco Moniche, José Antonio Sánchez-Miura, Lidia Ruiz-Bayo, Alejandro González.

Decrease in hospital admission for transient ischemic attack, mild, and moderate stroke during the COVID-19 era. Diegoli H, Magalhaes PS, Martins SC, Moro CH, Franca PH, Safanelli J, Nagel V, Venancio VG, Liberato RB, Longo AL.

Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era | Stroke; Henrique Diegoli; Pedro S.C. Magalhães; Sheila C.O. Martins; Carla H.C. Moro; Paulo H.C. França; Juliana Safanelli; Vivian Nagel; Vanessa G. Venancio; Rafaela B. Liberato; Alexandre L. Longo

The Curious Case of the Missing Strokes During the COVID-19 Pandemic; Diana Aguiar de Sousa, Else Charlotte Sandset and Mitchell S. V. Elkind; Stroke, Vol. 51, No. 7 (7): 1921-1923. DOI: 10.1161/STROKEAHA.120.030792

Acute Stroke in Times of the COVID-19 Pandemic; Carolin Hoyer, Anne Ebert, Hagen Huttner, Volker Puetz, Bernd Kallmünzer, Kristian Barlinn, Christian Haverkamp, Andreas Harloff, Jochen Brich, Michael Platten and Kristina Szabo; Stroke, Vol. 51, No. 7 (7): 2224-2227. DOI: 10.1161/STROKEAHA.120.030395

Delays in Stroke Onset to Hospital Arrival Time During COVID-19; Kay-Cheong Teo, William C.Y. Leung, Yuen-Kwun Wong, Roxanna K.C. Liu, Anna H.Y. Chan, Olivia M.Y. Choi, Wing-Man Kwok, Kung-Ki Leung, Man-Yu Tse, Raymond T.F. Cheung, Anderson Chun-On Tsang and Kui Kai Lau; Stroke, Vol. 51, No. 7 (7): 2228-2231. DOI: 10.1161/STROKEAHA.120.030105

What has caused the fall in stroke admissions during the COVID-19 pandemic?; Richard Perry, Azra Banaras, David J. Werring, Robert Simister

Acute Stroke Management During the COVID-19 Pandemic
Does Confinement Impact Eligibility for Endovascular Therapy?
Steven D. Hajdu, Valerie Pittet, Francesco Puccinelli, Wagih Ben Hassen, Malek Ben Maacha, Raphaël Blanc, Sandra Bracco, Gabriel Broocks, Bruno Bartolini, Tommaso Casseri, et al.

Effect of COVID-19 on Emergent Stroke Care: A Regional Experience; Jessica Hsiao, Emily Sayles, Eleni Antzoulatos, Robert J. Stanton, Heidi Sucharew, Joseph P. Broderick, Stacie L. Demel, Matthew L. Flaherty, Aaron W. Grossman, Charles Kircher, et al.

Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry; George Ntaios, Patrik Michel, Georgios Georgiopoulos, Yutao Guo, Wencheng Li, Jing Xiong, Patricia Calleja, Fernando Ostos, Guillermo González-Ortega, Blanca Fuentes, María Alonso de Leciñana, Exuperio Díez-Tejedor, Sebastian García-Madrona, Jaime Masjuan, Alicia DeFelipe, Guillaume Turc, Bruno Gonçalves, Valerie Domigo, Gheorghe-Andrei Dan, Roxana Vezeteu, Hanne Christensen, Louisa Marguerite Christensen, Per Meden, Lejla Hajdarevic, Angela Rodriguez-Lopez, Fernando Díaz-Otero, Andrés García-Pastor, Antonio Gil-Nuñez, Errikos Maslias, Davide Strambo, David J. Werring, Arvind Chandratheva, Laura Benjamin, Robert Simister, Richard Perry, Rahma Beyrouti, Pascal Jabbour, Ahmad Sweid, Stavropoula Tjoumakaris, Elisa Cuadrado-Godia, Ana Rodríguez Campello, Jaume Roquer, Tiago Moreira, Michael V. Mazya, Fabio Bandini, Karl Matz, Helle K. Iversen, Alejandra González-Duarte, Cristina Tiu, Julia Ferrari, Milan R. Vosko, Helmut J.F. Salzer, Bernd Lamprecht, Martin W. Dünser, Carlo W. Cereda, Ángel Basilio Corredor Quintero, Eleni Korompoki, Eduardo Soriano-Navarro, Luis Enrique Soto-Ramírez, Paulo F. Castañeda-Méndez, Daniela Bay-Sansores, Antonio Arauz, Vanessa Cano-Nigenda, Espen Saxhaug Kristoffersen, Marjaana Tiainen, Daniel Strbian, Jukka Putaala, Gregory Y.H. Lip. Originally published9 Jul 2020