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COVID-19 and Stroke: New Research Shows Coronavirus Linked to Stroke in Young People

young patient lying in ICU bed while doctor holds oxygen mask over her face because she has coronavirus and suffered a stroke

COVID-19 appears to cause major strokes in young, healthy patients, new data suggests.

In a recently published report in the New England Journal of Medicine, researchers from Mount Sinai Health System in Manhattan described five severe stroke patients under the age of 50. The youngest was only 31. All five tested positive for coronavirus.

While five cases may not sound like many, according to Dr. Thomas Oxley, a neurosurgeon at Mount Sinai, it represented a sevenfold increase of what they normally expect among patients in that age range. The vast majority of strokes occur in patients over the age of 65.

Similar cases have been reported in hospitals around the world. Even more concerning, the patients experiencing strokes all had mild cases of coronavirus. Some did not even realize they were infected.

Coronavirus Causes Severe Types of Stroke

MRI of stroke on brain caused by coronavirus

The reports also show that coronavirus patients are mostly experiencing the deadliest type of strokes, known as large vessel occlusions. These occur in major arteries, such as the middle cerebral artery, which supply blood to critical brain regions.

When a clot forms in one of these arteries, it can decimate entire sections of the brain and impair actions such as movement, speech, and memory.

Some of the clots are even appearing while doctors are treating the stroke, a phenomenon most have never seen before. Dr. Oxley told the Washington Post that while he was pulling out one clot in his patient, new ones were forming almost instantly around it.

Coronavirus also appears to cause blood clots throughout the body, and not just the brain. Experts have reported clots in various parts of their patients’ bodies, including the legs and lungs. Nephrologists at Mount Sinai have even noticed kidney dialysis catheters getting plugged with clots.

As Dr. Craig Coopersmith, professor of surgery at Emory University School of Medicine, explained to NPR, “Patients who are in the intensive care unit are always at risk of having clots, but nothing like the level we’re seeing with COVID-19.” 

Why Does Coronavirus Cause Blood Clots?

These facts have led doctors to conclude that the novel virus does not only attack the lungs as previously believed. It may also be attacking the blood vessels. Other theories suggest that the blood clots might be a result of the body’s immune response.

“When there is very active and severe inflammation in the body, the surface of blood vessels can become disturbed and the clotting system can be activated,” says Dr. Kathryn Hassell, a hematologist at UCHealth University of Colorado, in an interview with Health.com. She also says that other infections have been known to cause similar clotting problems.

The current data indicates that the new coronavirus attacks a specific cell receptor called ACE2. This receptor can be found throughout the body, including in the gut, lungs, heart, and blood vessel walls.

According to Dr. Oxley, if the virus binds to the ACE2 receptors in the blood vessels, this could cause them to become inflamed, leading to blood clots.

However, not everyone’s blood vessels have the same amount of ACE2. This factor is linked to a person’s genetics, not their age, which may explain why some young people are experiencing strokes.

This explanation, while persuasive, is still theoretical though. Research is currently being conducted on the link between inflammation, coronavirus, and stroke. As more information becomes available, the true picture will hopefully emerge.

Seeking Treatment For Stroke During Coronavirus

The good news is that large strokes like the ones seen in coronavirus patients are very treatable. By using clot-busting drugs and other techniques, doctors can effectively treat stroke and minimize permanent brain damage. However, this must happen with 6 hours of symptom onset.

Unfortunately, many people right now are reluctant to seek emergency care, for fear of exposing themselves to the virus. In fact, two of the five patients in the Mount Sinai report delayed treatment for over 24 hours for exactly this reason. But this delay can have devastating consequences.

Therefore, it is crucial to seek treatment as soon as stroke symptoms appear. To remember the signs of a stroke, think of the acronym F.A.S.T:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call 911

Other common symptoms include dizziness, numbness, confusion, and a sudden severe headache.

With a stroke, every minute counts. Do not wait to see if these symptoms clear up on their own. Even if you are young and healthy, the symptoms could signal a dangerous stroke.

Coronavirus and Stroke

Coronavirus patients, even those with seemingly mild symptoms, appear to be at a higher risk of stroke.

Although this fact is alarming, it’s important to realize that the actual rate of stroke in COVID-19 patients is still quite small, and the connection to stroke is still early speculation. Doctors have noticed a concerning trend, but the vast majority of patients do not suffer a stroke.

This means, if you have tested positive for COVID-19, you will not likely have a stroke. However, it is important to understand the risk and to learn how to recognize the early signs of a stroke. Swift diagnosis and treatment could mean the difference between life and death.

Finally, there is still a lot we do not know about COVID-19, and our understanding is always improving. For up-to-date information on the coronavirus and for the most recent health and safety guidelines, visit the CDC’s website.

Featured Image: ©iStock/Halfpoint

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