COVID-19, the disease caused by the SARS-CoV-2 virus, usually attacks the lungs. It causes symptoms that include cough and difficulty breathing — but doctors are noticing a disturbing trend.
People as young as 30 are experiencing strokes, even when their symptoms were mild.
“The coronavirus has been shown to cause development of microthrombi [small clots]. These clots can travel to the lung and obstruct blood flow to the lung, which is called pulmonary embolism, or travel to brain circulation and cause ischemic stroke,” Dr. Theresa Capriotti, DO, MSN, RN, at Villanova University, said.
“It seems to be happening to those affected with severe COVID symptoms,” Capriotti said. “It can occur in any age group and it occurs suddenly.”
Symptoms to watch out for include:
- weakness or paralysis of the extremities on one side of the body
- lack of sensation in extremities on one side of the body
- facial droop on one side of the face
- speech impairment
New York doctors ‘sound the alarm’
When doctors like Dr. Johanna T. Fifi at Mount Sinai saw unusual numbers of stroke patients with COVID-19 in March, she and colleagues decided to sound the alarm.
“We’re hypothesizing that the virus is having an effect on the lining of the blood vessels all through the body — and that is what is leading to the clots,” she said.
Their report was published in the New England Journal of Medicine (NEJM).
“We published that report because that was a little bit unusual to see so many young patients in such a short period of time,” said Fifi. “But we have some other research looking at our overall numbers, and we saw about double the amount of large vessel stroke than normal during the peak weeks of COVID.”
She confirmed it’s very likely these blood clots are COVID-19-related, and added that it can occur in any age group and can occur suddenly.
“It’s definitely something that it’s [COVID-19] doing, it seems too strong of an association to be unrelated at all, it’s just too much of a coincidence,” said Fifi. “What we know is that COVID is causing blood vessel blockages in other regions, the legs for instance, and COVID is damaging the blood vessel lining throughout the body.”
Severe cases and those with mild or no symptoms
According to Dr. Christopher P. Kellner, professor of neurosurgery at Mount Sinai, the kind of stroke that’s happening is severe stroke — meaning the patients had a large blood clot attach to one of the large arteries in the brain.
“We do know that COVID can increase your chance of developing blood clots if you have severe COVID. Especially if you’re old; older people are more likely to have severe COVID,” he said.
Kellner explained this is why in April, Mount Sinai implemented a plan to give anticoagulant drugs to people with COVID-19. “The reason this is important is we observed this happening in younger patients with no or mild symptoms.”
However, he emphasized “no one recommends that yet for patients at home, with mild disease. But we’re still figuring out the disease and what makes sense to do.”
Risk of infection not high enough to prevent timely stroke care
Precautions against COVID-19 can delay stroke treatment, according to a recently published report in Stroke, a journal of the American Heart and American Stroke associations.
But researchers find this risk isn’t high enough to prevent patients from receiving timely, life-saving care.
“Endovascular treatment for stroke involves the use of small catheters inserted from the groin or the arm into the blood vessels of the brain to remove a clot and restore blood flow to the brain,” said Dr. Aaron Grossman, assistant professor at the University of Cincinnati (UC), and corresponding author on the report in a statement.
Grossman explained that this process opens blocked arteries in the brain, reversing the effects of stroke and leading to faster recovery in some patients.
He points out that “In this current climate, the treatment presents challenges that doctors never previously needed to consider.”
Treating stroke patients while avoiding infection
Dr. Matthew Smith, report lead author and UC Health physician said they needed to “find a process for treating patients using endovascular therapy in the COVID-19 era that would keep our staff safe while we cared for these patients as quickly as possible.”
As the first people with COVID-19 were arriving at UC’s Comprehensive Stroke Center, members of every team treating them met via video to establish recommendations for care.
Researchers also reviewed the anecdotal experiences of providers caring for COVID-19 patients nationally and internationally.
They concluded that a COVID-19 diagnosis shouldn’t prevent doctors from using endovascular therapy to treat a patient’s severe stroke.
“However, we have to use extreme caution when preparing the patient, to keep staff safe,” added Smith. “And during this time of extreme resource limitation, we have to be prepared to modify our current protocols to provide the best stroke care possible for all patients in the Tristate.”
The bottom line
Although typically considered a lung infection, COVID-19 has been found to cause blood clots that can cause severe stroke.
Experts say that this can happen in any patients regardless of age, and even in those with few or no symptoms.
Because of this, Mount Sinai Hospital in New York City began treating people with blood thinners in April.
Concerns regarding infection could delay stroke treatment, but research suggests that a COVID-19 diagnosis shouldn’t prevent doctors from using life-saving procedures.
Medical reference: healthline