In the past week, we have really gotten to appreciate how little we know about the COVID-19 and that we should be prepared for surprising and unexpected developments with regards to the disease.
This week, in three large medical centers in New York, Manhattan and Philadelphia, there have been unprecedented reports of COVID causing severe strokes in young and middle-aged adults who were previously healthy. Usually, strokes occur in seniors who are in their 70s with high-risk conditions such as diabetes, high cholesterol, chronic kidney disease and smoking. The number of reported cases is still small but they still represent a seven-fold increase because strokes so rarely are seen in young people.
The reports are of adults in their 30s, 40s and 50s who did not have any chronic medical conditions.
Alex – first, can you tell me what is a stroke and how are they caused?
Wendy – a stroke is a disruption in the blood supply to an area of the brain that results in brain tissue dying as it is deprived of oxygen and nutrients. A stroke can be caused by a blood clot in a blood vessel or a bleed in the brain.
Alex – other than the age of the patients, are there any other features about these COVID related strokes?
Wendy – What’s unique about these COVID related strokes is that: first, they are appearing in a younger population; second, they are all clots in large blood vessels which means a large area of the brain is affected; third, the onset is rapid and there is often blood clots found in other parts of the body; fourth, the patients had no or minimal symptoms of fever or cough that are typically what we attribute to being symptoms of COVID.
Alex – is there anything we know about how these COVID related strokes are caused and how to prevent them?
Wendy – Alex, the reports of these COVID related strokes just occurred this week in the US, so almost nothing is known yet. We know that in Wuhan, 5% of those hospitalized with COVID had strokes It is only speculation at this time about how COVID causes strokes, why there is a predilection for the younger patients, and what is the disease pathology and therefore how we can prevent them.
Because the blood clots are in large vessels and are found in other parts of the body. I suspect that they are a result of some sort of systemic response to the virus meaning a response that is mounted by the entire body. And the response could be an inflammatory response, immune response or some have thought a consumption of blood products that prevent our blood from clotting.
At this time, we don’t know if there is a way to prevent these strokes from preventing because we don’t know how they are caused. However, the good thing is that these strokes are treatable if medical attention is sought within hours of the first symptoms. The treatments that we have are infusions of blood thinners or to thread a catheter (thin flexible tube) through the carotid artery to retrieve or break up the clot. The best results are when treatment is done as soon as possible and ideally within 6 hours of symptoms appearing.
Sadly, all the cases we saw of the COVID strokes, the patients were reluctant to go to the hospital and delayed treatment. I think there is an element of denial of the symptoms and there is also a reluctance to go to the hospital for fear of contracting the virus.
However, treatment should be sought as soon as possible at a hospital when symptoms present. We say that every minute is brain tissue dying.Â
Alex – what are symptoms that should prompt someone to go to the hospital immediately?
Wendy – slurred speech or trouble swallowing, weakness or numbness in the arms or legs, vision changes, a new asymmetry in the face or posture. I would also say, instead of driving yourself or riding with a friend, call 911 for an ambulance so that you can get to the hospital quicker and starting treatment such as oxygen on the way to the hospital.
To listen to Dr. Wendy’s full GET episode on Coronavirus Outbreak and Healthcare System in the US click HERE.
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