COVID-19 linked to strokes in middle-aged people

Reports of COVID-19 related strokes in middle-aged people makes it all the more important to know the stroke symptoms

Doctors are learning more about COVID-19 and as 22 April 2020, Dr Thomas Oxley, a neurosurgeon at Mount Sinai Health System in New York reported five patients under the age of 50 presenting with stroke. Since none of the patients had any prior risk factor for stroke, the strokes were attributed to COVID disease itself.⁵

Prof Pamela Naidoo of the Heart and Stroke Foundation South Africa states that “this clinical information is crucially important in managing the complications of COVID-19 while we await evidence from well-controlled studies to understand the pathogenic pathways for COVID-19 and stroke”.

Don’t ignore stroke symptoms because of COVID-19

Despite this association with COVID-19, neurologists across the world are reporting a drop in the number of acute stroke patients seeking emergency care during the pandemic. It’s possibly because many fear coronavirus exposure at hospital emergency rooms.

But stroke remains a disabling event, with a higher fatality rate than currently recorded coronavirus fatality. Previous data estimates up to 360 South Africans are affected by strokes daily. About a third of those who suffer a stroke will die, and a quarter will be left with life-changing disability.¹

Dr Patty Francis, president of the Neurological Association of South Africa (NASA), Angels Initiative Steering Committee Member and lead stroke neurologist at Netcare Umhlanga Hospital urges members of the public who experience symptoms of a stroke to go to their nearest emergency room without delay.

COVID-19 and the ER

“Hospital emergency departments are now partitioned into specific triage areas for COVID-19 PUI (persons under investigation) and “other” patients. Extreme measures are in place to ensure that patients are safe from contracting the virus. All elements of acute stroke care are still available during the COVID-19 pandemic and patients who have symptoms of a stroke should seek immediate care at the nearest stroke ready centre,” says Dr Francis.

What happens during a stroke?

A stroke occurs when oxygen supply to the brain is decreased by a blockage or damage to a blood vessel in the brain. This causes brain cells to die.

Large or critical strokes can be fatal or result in disability.²

There is clear evidence of increased clotting caused by COVID-19 infection.⁵This may be a contributor to the apparent increase in stroke risk, although multiple factors are likely to be detected as the research unfolds.

The chances of recovery from a stroke depend on rapid recognition that they are experiencing a stroke and getting them to an emergency hospital FAST.

With an estimated population of 58 million citizens, South Africa needs an average of 283 Stroke Hospitals and 60 comprehensive Stroke centres. Clearly not every citizen will have an emergency facility within range. For such individuals, the message still remains: get rapid access to any local medical doctor closest to you.

What are the symptoms of a stroke?

If you suspect a stroke, quickly do the BEFAST test:³

BALANCE: does the patient have a sudden loss of balance or co-ordination
EYES: is there blurred vision or loss of vision
FACE: smile and see if one side droops
ARM: raise both arms. Does one arm drift down?
SPEECH: repeat any sentence. Is there trouble speaking or understanding?
TIME: time saved is brain function saved. NB: A person loses 1,9 million neurons each minute in which stroke is left untreated.⁴ Every minute counts in SAVING YOUR BRAIN!

For more information on stroke and COVID-19 please visit the following websites:

Heart & Stroke Foundation South Africa: //www.heartfoundation.co.za/stroke/
Neurological Association of South Africa (NASA): https://www.mynasa.co.za/
Covid-19 South Africa: https://sacoronavirus.co.za/

References:

Connor M & Bryer A (2006). Stroke in South Africa, Chronic Diseases of Lifestyle in South Africa since 1995 – 2005, MRC Technical Report.
Maredza A. et al (2015). Disease burden of stroke in rural South Africa: an estimate of incidence, mortality and disability adjusted life years. BMC Neurology, 15:54.
Melanie Y Bertram, the disability adjusted life years due to stroke in South Africa in 2008, International Journal of Stroke, 2013
National Stroke Association’s Complete Guide to Stroke, stroke.org
Stroke symptoms, https://www.stroke.org/en/about-stroke/stroke-symptoms
Time Is Brain-Quantified, www.ahajournals.org/doi/full/10.1161/01.STR.0000196957.55928.ab
Maggie Fox (2020). Covid-19 causes sudden strokes in young adults, doctors say, viewed 24 April 2020, https://edition.cnn.com/2020/04/22/health/strokes-coronavirus-young-adults/index.html