OverviewA per the World Stroke Organization, over 13 million people worldwide will have a stroke this year, and around 5.5 million people may die as a result. Stroke can have different short- and long-term effects on patients depending on what part of the brain was affected and how quickly is it treated. Stroke is a neurological condition where a patient develops weakness of one half of the body as blood supply to the brain is disrupted. The disruption happens most frequently by a clot in an artery that supplies blood to the brain, a situation called ischemia. Stroke can also be caused by hemorrhage where blood leaks out of the blood vessels of the brain following rupture of the blood vessels. Stroke can cause permanent damage, such as partial paralysis (one half of the body) and impairment in speech as well as comprehension and memory. The location and extent of the damage determine the severity of the stroke that can range from minimal to catastrophic damage.
COVID-19 and Strike – The LinkBoth anecdotal evidence, as well as research during this pandemic, suggest a striking correlation between COVID-19 and increased risk of stroke. This is prevalent irrespective of gender or age and is predominant across all segments of the population. Besides, any existing comorbidity like high blood pressure, obesity, diabetes etc. can increase the chances of stroke in a COVID infected patient due to the decrease in the supply of oxygen to the brain. As per the July 2020 study in JAMA Neurology, the risk of stroke looks to be higher with COVID-19; possibly 7 times higher among COVID-19 patients than among those with flu. The enhanced risk may be linked to increased inflammation and an immune reaction, both of which are related to the clotting system. When inflammation results in a clot which can trigger a stroke, it is called thrombo-inflammation. Strokes affect about 1 – 3 per cent of hospitalized COVID-19 patients, who, in general, are a small fraction of COVID-19 patients. The risk increases to 5 – 6 per cent for patients in ICU (intensive care units).
Frequently Asked QuestionsIs There a Link Between COVID-19 and Brain Stroke? COVID-19 causes coagulopathy, which increases the risk of clot formation in many parts of the body, like lungs, legs and brain. If clot forms in the arteries supplying blood to the brain, it can lead to stroke. About 5 per cent of patients with severe COVID-19 develop stroke”. How to know if someone is having a stroke? Stroke symptoms can be recognized by the acronym FAST. “F” stands for facial droop or weakness on one side. “A” stands for arm weakness on one side. “S” stands for speech impairment (slurred speech or inability to speak or comprehend). “T” stands for time, as stroke is a medical emergency and needs prompt treatment. What causes stroke in COVID-19 patients? COVID-19 causes inflammation of various organs. It also leads to coagulopathy, which increases the chances of clot formation in arteries supplying blood to brain. These factors lead to brain stroke. What types of strokes are seen in COVID-19 patients? COVID-19 can lead to two types of arterial strokes- ischemic and hemorrhagic. In ischemic stroke, blood supply to a part of brain is reduced. In hemorrhagic stroke, there is internal bleeding in brain. Another type of stroke is cerebral venous sinus thrombosis (CVST), where there is clotting in brain veins. Are young individuals with COVID-19 at higher risk for (or prone to) stroke? Young patients tend to have milder or asymptomatic COVID-19 infection, where the risk of stroke is lower. However, compared to young individuals without COVID-19 infection, those with COVID-19 infection tend to have a higher risk of developing stroke. In fact, recent research shows that stroke can be the first sign of COVID amongst patients below the age of 45 years. Younger people tend to have a more severe stroke due to large vessel involvement. How important it is to be aware of stroke amidst COVID-19 pandemic? Stroke is more common in patients with COVID-19 infection. All stroke patients need emergency treatment to ensure the best outcomes. In the times of COVID-19 pandemic, resources are more focused towards treatment of COVID-19 patients, which may lead to delays in providing the best stroke care. Therefore, one must be aware of stroke symptoms and rush to the nearest “stroke-ready” hospital, if any symptoms are noted. Is COVID-19 related stroke different from stroke without COVID-19 infection? The symptoms, signs and treatment of COVID-19 related stroke are similar to stroke without COVID-19 infection. However, care is needed to prevent the spread of COVID-19 from patient to healthcare professionals and other patients in the hospital. What precaution should stroke survivors take to prevent another stroke during this pandemic? Stroke survivors should regularly take blood thinners and statins (as prescribed by their doctors). They should keep their blood sugar within normal limits (target glycosylated haemoglobin <7%). BP should be kept below 130/80 mmHg. Obese and overweight people should lose weight. Regular exercises should be done. Take Home Message Patients with COVID-19 have a higher risk of developing stroke. Stroke can be the first manifestation of COVID-19 (can occur in the absence of fever, cough, breathing difficulty). Stroke in COVID-19 can occur in young individuals (<45 years of age) and in the absence of traditional risk factors (such as diabetes, hypertension, high cholesterol, obesity, etc). If one notices symptoms of stroke, don’t stay at home due to fear of corona, and rush to the nearest “stroke-ready” hospital for emergency treatment. Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) Consultant Neurologist Apollo Hospitals, Hyderabad