By LISA EISENHAUER
June 23, 2020
Among the many mysteries physicians and researchers are trying to solve regarding COVID-19 is why the deadly virus may be correlating with severe strokes in a small number of patients under the age of 50 who typically wouldn't be considered at high risk.
Dr. Hakeem Shakir, a neurosurgeon and the director of endovascular neurosciences at SSM Health St. Anthony in Oklahoma City, is among those eager to understand the connection. The link was documented in April by doctors treating patients for the infection at Mount Sinai Health System hospitals in New York City.
While the connection is under study, Shakir is worried that the fears generated by the spread of COVID-19 may cause people with stroke symptoms to delay medical care. The observational report by the Mount Sinai physicians on five COVID patients who suffered strokes believed to be related to the virus was published on the New England Journal of Medicinewebsite April 28. One of the cases involved a previously healthy 33-year-old woman who had fever, headache and chills lasting a week followed by numbness and weakness in her left arm and leg that lasted for 28 hours.
The authors said she delayed medical care for fear of contracting COVID, although when she did seek care, she tested positive for COVID, had suffered a stroke and had blockages in a cerebral artery and a carotid artery.
Since the start of the pandemic, hospitals had warned that patients were delaying emergency care to reduce their risk of contracting the novel coronavirus. That means patients might not be connecting symptoms of COVID-19 and potential indicators of stroke, Shakir said.
"We know that there's a correlation between COVID-19 and stroke in people under the age of 50," Shakir said. "At the same time, those people are for whatever reason delaying their presentation to the emergency departments" when they have symptoms of stroke.
Physicians have long known that advanced age and chronic conditions including diabetes and high blood pressure elevate an individual's risk of stroke. But until the doctors in New York noticed strokes among several coronavirus patients there, the virus wasn't seen as a contributing stroke factor, Shakir said.
The strokes suffered by the patients younger than 50 with COVID-19 in the Mount Sinai report were not mild ones, he pointed out. "It's not just a small blood vessel in the brain that gets affected," he said. "The COVID patients are getting large vessels blocked off with clot."
Although Shakir has not treated any patients who match the examples seen by the report's authors, he is grateful that they sounded the alarm for him and other physicians. Shakir and other stroke specialists are urging the public to be aware of common stroke symptoms, such as slurred speech and impaired vision.
Why select patients who are younger than 50 and otherwise healthy before they contract COVID may be at heightened risk for large vessel ischemic stroke is "the billion-dollar question," Shakir said. Finding out if the patients have similar characteristics, such as smoking or dehydration, will require study. "We need to look closely at the patients who have had strokes, these younger folks, and really examine what sets them apart," he said.
In the meantime, he said, the adage among stroke specialists that "Time is brain," meaning the sooner a stroke victim gets treatment the better the outcome, holds true. "It is imperative for people to not be dismissive of their symptoms," he said.
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