Why is COVID-19 Infection Causing Strokes in Healthy Adults Under 50?
Around the world, stroke physicians are reporting an increase in cases of adults under age 50 who are having strokes triggered by the novel coronavirus. The New England Journal of Medicine recently published findings based on cases in New York City, the U.S. epicenter of the pandemic. Some of these stroke patients were otherwise generally healthy and experienced mild or no symptoms of COVID-19 infection, though they tested positive for the virus.
“We are definitely seeing this in our practice in the last several weeks,” says Amer Malik, M.D., a neurologist and stroke expert with the University of Miami Health System. “My colleagues at UHealth and Jackson Memorial Hospital have completed multiple emergency thrombectomy procedures in young patients in recent weeks. This trend is also occurring to colleagues in other major metropolitan areas of the country.”
More research needs to be conducted to determine why infection from the novel coronavirus may increase the risk for ischemic strokes in the brain and neck arteries.
“One hypothesis is that viral infections like COVID-19 can trigger an overproduction of activated immune cells, termed a cytokine storm,” says Dr. Malik. “Individuals experiencing this surge of activated immune cells could potentially be at higher risk for strokes as well as blood clots in other organs.”
In addition, clotting disorders may be a symptom of severe COVID-19 infection itself, according to findings recently published in the Journal of the American College of Cardiology.
Underlying health conditions such as high blood pressure, diabetes, heart disease, high cholesterol, having a hole in the heart, atrial fibrillation, and obstructive sleep apnea often predispose patients to develop ischemic strokes.
“Patients with any of these risk factors who also get infected with the novel coronavirus may also have a higher occurrence of blood clots and strokes,” says Dr. Malik. Younger adults (age 30 to 50) sometimes have undiagnosed diseases and conditions like these that raise their risk for stroke.
Younger adults also tend to avoid trips to the ER, even when signs of stroke present themselves. Strokes among younger adults may be ignored or presumed to be not very serious.”Dr. Malik
Signs of stroke present themselves suddenly, in any order, and can vary from mild to severe. If you are experiencing or witnessing someone having signs of a stroke, doctors want you to “BE FAST.”
B = balance (sudden imbalance, trouble walking, or falling to one side)
E = eyes (double vision)
F = face (drooping or sagging on one side)
A = arm (weakness on one side of the body)
S = speech (slurred or difficulty expressing and understanding words)
T = time (quickly call 911)
There are potential therapies available to patients who are quickly admitted to an ER.
Any delay in treatment for stroke can lead to further brain damage and disabilities, coma, or death. In some cases, symptoms of stroke can resolve within a couple of hours. But, these transient ischemic attacks (called TIAs or “mini-strokes”) remain a significant risk and require immediate medical attention to help prevent more serious brain attacks that lead to permanent neurological disability.
“Many people are hesitant to enter an emergency room during the COVID-19 pandemic,” says Dr. Malik. “Across the country and within Florida, we are seeing a decrease in the number of overall stroke admissions at hospitals. We know people are still experiencing life-threatening strokes or having warning events like TIAs. We don’t want them staying home and delaying treatment due to fear of going to the ER. We are taking proper precautions to keep both patients and healthcare professionals protected. The bottom line is stroke is still a medical emergency that requires immediate medical attention, even during a global pandemic.”
Dana Kantrowitz is a contributing writer for UMiami Health News.