Scientists are starting to learn more about the impacts of COVID-19 on our bodies. We know that it can attack the lungs and result in severe inflammation, which would reduce its main function: to transfer oxygen from the lungs to the bloodstream via red blood cells. However, the virus also attacks other organs in our body such as the kidney, heart, and brain. The part that would be the most affected is our blood vessels, which could lead to the formation of blood clots or even excessive bleeding.
According to Forbes, a global media company focusing on business, investing, technology, entrepreneurship, leadership, and lifestyle, the virus specifically attacks larger blood vessels that feed important parts of the brain critical to movement, thinking, and breathing. Thus, stroke cases among COVID-19 patients are observed.
Recently, medical professionals treating COVID-19 patients, who later are diagnosed or recovering from the disease, have noted an increase in strokes among young people and otherwise healthy adults. "We noticed a lot of the patients coming in were very young and some of them didn't have any traditional risk factors for stroke, except that they were testing positive for COVID-19," Johanna Fifi, MD, a neuroendovascular surgeon at Mount Sinai, said.
Why Young COVID-19 Patients Experience Strokes
Last March, many health professionals saw unusual numbers of stroke patients with COVID-19. Dr. Fifi and her colleagues were the first ones to notice this trend. “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.
Data from a New York City health system revealed that five COVID-19 patients ages 33 to 49 have developed acute ischemic large-vessel stroke. According to MedPage Today, an online site that provides free continuing education to healthcare professionals in addition to the latest news, stroke was the presenting symptom of COVID-19 in two of the cases. In the other three cases, COVID-19 symptoms were mild: cough, headache, lethargy in some, and one report of fever.
"We realized we had seen five young people with large vessel stroke within 2 weeks when we normally see less than one patient that young every 2 weeks. This was seven times our normal rate," Fifi said.
Pascal Jabbour, MD, of Thomas Jefferson University Hospital in Philadelphia, said that similar cases were also seen at other hospitals. For instance, 12 COVID-19 patients were treated for stroke from March 20 to April 10 at NYU Langone. Health professionals were surprised to find out that young patients didn’t have any risk factors for stroke. The study confirmed that the blood clots found in the patients’ bodies were related to the disease.
“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. 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,” Fifi said.
Dr. Christopher P. Kellner, professor of neurosurgery at Mount Sinai, added that the patients experienced a severe stroke. This means that they had a large blood clot attached to one of the large arteries in the brain. One theory that could explain this is that COVID-19 induces inflammation, which causes the thickening of the blood and can result in a severe type of stroke in otherwise healthy young adults.
The Strokes Observed Were Unlike What Doctors Usually See
One surprising fact out of all of these is that strokes in young people are extremely unusual, especially strokes in the large vessels in the brain. According to CNN, an American news-based pay television channel owned by AT&T's WarnerMedia, a team of health professionals revealed that they have treated on average 0.73 patients every 2 weeks under the age of 50 years with large vessel stroke. That's fewer than two people a month.
If not treated immediately, stroke cases among young COVID-19 patients can be dangerous. It could kill their brain cells when the blood flow stops. The longer it's blocked, the wider the damage in the brain. Thus, quick treatment is extremely important. "The most effective treatment for large vessel stroke is clot retrieval, but this must be performed within 6 hours, and sometimes within 24 hours," Dr. Thomas Oxley, a neurosurgeon at Mount Sinai Health System in New York, said.
A recent study conducted by the surgeons at Thomas Jefferson University revealed that the strokes they observed were unlike what they usually see. According to Science Daily, an American website that aggregates press releases and publishes lightly edited press releases about science, they examined 14 patients who had come into their Neurointerventional room for stroke. Half of the patients were not aware they had the coronavirus, while the rest were already being treated for other symptoms of the disease when they developed stroke.
The findings revealed that the incidence of coronavirus in the stroke population was 31.5% and the mortality rate in these COVID-19 patients is 42.8%. The typical mortality from stroke is around 5 to 10%. It was also found that the observations in these patients are unusual in stroke patients. "We were seeing patients in their 30s, 40s, and 50s with massive strokes, the kind that we typically see in patients in their 70s and 80s," Jabbour said.
"Although we have to stress that our observations are preliminary, and based on observations from 14 patients, what we have observed is worrying. Young people, who may not know they have the coronavirus, are developing clots that cause major stroke,” Jabbour added.
Felipe De Los Rios, M.D., the medical director of the Stroke Program at Miami Neuroscience Institute, said that the numbers of COVID-19 patients affected by strokes appear to be small and should not panic the public. “We will need more studies, larger studies with multiple centers, to try to grasp the magnitude of that increased stroke risk. It’s most likely not very large. The vast majority of people are not going to have a stroke associated with COVID-19,” he said.