 Good morning one and all. This is Dr. Anjani from Great Eastern Medical School and Hospital Raghavallu, Srikakulam. Today my topic of paper presentation is on acute cerebral vascular events with COVID-19. Coming to introduction, in December 2019, the epidemic of coronavirus disease caused by severe acute respiratory syndrome virus was first reported in Wuhan in China. And the rapid spread of COVID-19 has made it as a public health emergency of international concern. As of October 2021, over 40 million people were confirmed to be infected with SARS-CoV-19 globally, with over 7 lakh confirmed deaths worldwide. While COVID-19 is mostly known for causing severe respiratory distress, a growing number of neurological manifestations has been reported. Patients with severe COVID-19 has commonly complicated neurological symptoms, including consciousness impairment in about 14.8% of the cases and skeletal muscle symptoms in about 19.3% of the cases. And previous studies have suggested that bacterial or viral infection may be a trigger for this acute ischemic stroke, probably related to the pro-thrombotic effect of the inflammatory response. Coming to the background and purpose of my study, my study is to determine the risk of cerebral vascular disease in patients with recent or past history of COVID-19 infection. Coming to my methods that are used in this study, my study is a single-central retrospective observational one and a total of 100 patients who underwent CT-brain for suspected cerebral vascular disease that are referred from casualty in our hospital with present or past history of COVID-19 were evaluated for demographic details such as AIDS, sex, comorbidities, after obtaining the informed consent from these patients. And after taking the informed consent, we have performed a multi-detector CT from base of the skull to vertex. Coming to the results of my study, out of the 100 patients with confirmed SARS-CoV-19 infection, 10 of these patients developed a new onset of cerebral vascular disease following COVID-19 infection. Of these patients, eight were diagnosed with ischemic stroke and two had intercellular hemorrhage. And the representative CT-brain images of the patient one with ischemic stroke and patient ten with intercellular hemorrhage were shown. And the age of these patients ranged from 75 years to 57 years to 75 years with a median age group of 62 years. And out of these 10 patients, four were females with two patients having coronary artery disease and two had diabetes with hypertension. And the majority of the people with the male ones, that is six patients were male with four had a power past history of myocardial infarction with type 2DM and hypertension. And one patient had diabetes with smoking. And one patient had a history of hypertension with deep venous thrombosis. And the main neurological hallmark in the imaging was acute ischemic infarcts. And out of these infarcts, large vessel infarcts were the common ones, including the median cerebral artery, posterior cerebral artery, and anterior cerebral artery. And out of the 10 patients, eight had a high CVRT score and two had moderate disease. And the below slides are the pie chart representation of the demographic details of the patients on comorbidities that are associated with COVID-19 infection. And in our study, the majority of the population are male population and the 40% of the people being the females. And the majority of the cerebral vascular events were the ischemic stroke in 80% of the population and 20% were the hemorrhagic stroke. And these are the pie charts showing the comorbidities that are associated with the cerebral vascular disease in the male patients and the female patients. These are the non-contact CT brain images showing acute to subacute infarcts in the left frontal temporal, frontal temporal perital and peritoccipital regions. And again, this is an axial non-contact CT brain showing a well-defined hypodensity in the left occipital lobe with loss of gray-white matter differentiation and posthumous effect with the local sulcular face bed and male compression of trigonal flatal ventricle. Again, these are the axial non-contact CT brain images showing an ill-defined hypodency areas in the left cerebral convexity involving the left frontal, perital, temporal and occipital lobes, left capsular ganglionic region, centrum semi-voval, and left coronary radiata with the effacement of the occipital sulcus that is to subacute infarction. Again, these are the axial CT brain images showing a relatively well-defined hypodense area of hemorrhagic attenuation of HU 61 with a measurement of 3.7 into 2.6 into 1.6 centimeters with surrounding hypodense area suggestive of edema that was noted in the left capsular ganglionic area with mild compression of the frontal horn of left lateral ventricle suggesting intrapirant camel hemorrhage. Coming to the discussion of our study 10 patients with COVID-19 developed the cerebrovascular event following the infection with COVID-19 and patients with the cerebrovascular disease were older and were more likely to have cardiovascular and cerebrovascular risk factors and these findings suggested that elder patients with COVID-19 may be more likely to develop these cerebrovascular diseases and more attention should be paid to older patients with these cerebrovascular risk factors. Coming to the stroke mechanisms in the COVID-19 in a review on the central nervous system viral infection that is by Q net all concluded that all viruses can reach the CNS under certain specific conditions depending upon the viral factors such as mutations in specific illness genes and host factors such as immunosuppression, age of the patient and their comorbidities and these neurological manifestations can be seen in these patients with viral infection specifically COVID-19 mainly because of the condition called cytokine storm including the pro-inflammatory and anti-inflammatory cytokines as an immune reaction to the viral infection infecting the central nervous system such an exaggerated response to this infection it can be it can lead to cerebrovascular disease, meningitis encephalitis, meningoencephalitis or sometimes it may even lead to death coming to conclusion of my study my study shows that acute ischemic stroke was infrequent in patients with COVID-19 and it occurs and it usually occurs in those with more severely infected and with the presence of other cardiovascular and cerebrovascular risk factors and following are my references and thank you one and all