A stroke could be a sign of Covid-19
There’s emerging evidence that a stroke could be a rare but important presentation of #Covid-19 in younger adults
Thromboembolic complications(i.e. clotting problems in the blood) of critically ill patients with COVID-19 are well known by now.
In fact, any critical condition that forces you to stay in the ICU for long periods, immobile and ill, will put you at risk for clotting problems. Venous pumps in the legs won’t work as well, blood will stagnate and with time clots can form in the leg veins which gives rise to Deep vein thrombosis(DVT).
These clots can sometimes break apart and if a small part of that travels up and lodges in one of the arteries that supply blood to your lungs, it could cause Pulmonary Embolism(PE), a life-threatening condition in the lungs causing severe breathing issues.
Severe Infection can lead to clotting abnormalities
Further, severe infection in the blood, otherwise known as sepsis, can cause our immune system to react in crazy ways, resulting in increased clotting tendency and an increased bleeding tendency at the same time. This disastrous condition is known as Disseminated Intravascular Coagulation(DIC). In the case of COVID-19, it could be a complication of secondary bacterial infection in ill patients, or sometimes the virus itself.
Evidence of Increased clotting abnormalities in Covid-19 Patients
Our knowledge of this pandemic-causing virus and its clinical picture is evolving. While a few studies reported a high frequency of clotting problems, the most remarkable evidence was that the problems were more commonly present in critically ill patients, and those who unfortunately didn’t survive the disease. This points towards the fact that the clotting abnormalities and incidence of thrombosis and stroke were mostly due to the body’s inflammatory response to the severe infection causing the immune system to act crazy. All of those studies, including a Dutch study published in Thrombosis Research recently which reported a remarkably high percentage(31%) of thrombotic complications in Covid-19 patients, was inconclusive whether this finding was due to some inherent property of the novel coronavirus; it could well be that these patients were critically ill, putting their immunity system out of control. (the Dutch study was done observing ICU patients).
What I want to share with you is one startling detail this study reveals: the stroke was the presenting condition of these five patients. Their only symptoms were the symptoms of stroke, they had either no or very mild Covid-19 related symptoms at presentation.
This New Evidence is Different
But this emerging evidence is something different. Medscape and its editor and leading health researcher Dr.Eric Topol reported on 24th April about “five cases of large vessel stroke over a 2-week period in COVID-19 patients under age 50 years.”
This study was done by a team of researchers lead by Dr.Thomas Oxley, at the department of neurosurgery, Mount Sinai Health System. He also highlighted that this represents a “seven-fold increase” compared to what is normally expected. Now, this could be in comparison to what is expected normally in Covid-19 patients under 50 years, although we’ll have to wait for further details until 29th April, when the study will be published in New England Journal of Medicine as a rapid communication.
There is one startling detail this study reveals: the stroke was the presenting condition of these five patients. Their only symptoms were the symptoms of stroke, they had either no or very mild Covid-19 related symptoms at presentation.
There has been a clear reduction of stroke patients receiving care in USA hospitals, presumably due to patients being reluctant to seek medical care due to the ongoing condition. So this rare but unusual presentation and its occurrence in younger adults is a matter of concern.
So does this matter in the larger scheme of things?
It matters, not to everyone everywhere; but to the USA, where the number of confirmed cases stands at 959K with over 50K deaths and counting. When the infection is so widespread, rare possibilities become real possibilities. So if you live in an area where the number of cases is high and counting, this rare presentation with stroke could be a distinct probability.
Stroke, even if it’s not a symptom of Covid-19, is a medical emergency. 25% who gets one dies. This is just one more reason not to neglect it.
