Neurosonology during the COVID-19 pandemic (Editorial commentary from the chairs of the ultrasound panel of the European Academy of Neurology).

The COVID‐19 pandemic is seriously affecting the lives of billions of people around the world, especially in the healthcare systems [1]. Although the impact of the pandemic on health services is mostly negative, there is still a chance to use this situation as an opportunity for positive changes.

Neurosonological examination involves direct contact between the patient and the sonographer, often for several tens of minutes. Thus, this examination should be included in procedures with a potentially high risk of COVID‐19 transmission.

To prevent the spread of viral infection, the Management Group of the Scientific Panel on Neurosonology of the European Academy of Neurology [2] and the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) [3] published their recommendations for neurosonology laboratories and the performance of neurovascular ultrasound, based on general international ultrasound/neuroimaging investigation guidelines during the pandemic [1, 4, 5, 6, 7, 8].

In contrast to elective neurosonology examination, the acute examination cannot be postponed, especially in acute stroke patients. To diminish the risk of viral infection transmission during neurosonological examination, Baracchini et al. are providing practical recommendations of the ESNCH for the performance of neurovascular ultrasound investigations with the aim of protecting both patients and ultrasound providers [9]. The recommended detailed pre‐hospital and intra‐hospital assessments, regular effective cleaning of ultrasound equipment and using compatible disinfectants after each patient are necessary to diminish the spread of viral infection. The indication for neurosonological examination becomes even more crucial now.

Nevertheless, the correct assessment of neurosonological examination is not only a question of image evaluation as in other neuroimaging methods but it is ‘state of the art’, highly dependent on sonographer experience [10]. Thus, hands‐on courses are necessary to provide adequate education and practice for neurosonographers. The COVID‐19 pandemic has also seriously affected these educational activities. It is an urgent challenge for authorities (ESNCH, European Academy of Neurology Scientific Panel on Neurosonology and Neurosonology Speciality Group of the World Federation of Neurology) to create a suitable, safe, effective and modern system of neurosonology education able to protect participants but to continuously deliver up‐to‐date neurosonology information.

Facing the COVID‐19 pandemic, currently various new digital educational concepts are being developed for distance learning and we should therefore share these broad experiences for future courses, but this is yet another demanding task for the neurosonology community. It is an ultimate goal to increase the use of interactive video conferencing in remote neurosonology education as well as in the delivery of acute stroke care, known as telestroke/teleneurosonology, also feasible and very efficient during the crisis. Among the first steps, sonographers should complete infection control and protection training using these interactive remote modalities.

The major goal of all relevant recommendations of neurosonology societies or authorities is to protect both patients and sonographers but keeping great attention on stroke as an emergency condition always strictly adhering to treatment guidelines for patients to ensure appropriate stroke care. The introduction of published recommendations on clinical practice may also mitigate the negative effects of new pandemics in the future.

Disclosure of conflicts of interest

The authors declare no financial or other conflicts of interest.