Coronavirus could cause deadly strokes in patients aged 30-40 years despite mild symptoms, says report
The new coronavirus might be causing sudden strokes in patients in their 30s and 40s with mild to no symptoms of COVID-19, according to researchers. Investigators from the Mount Sinai Health System in New York City have reported five cases of stroke over a two-week period in COVID-19 patients, all aged below 50, which they say is a seven-fold increase over the norm.
"The virus seems to be causing increased clotting in the large arteries, leading to severe stroke. Our report shows a seven-fold increase in the incidence of sudden stroke in young patients during the past two weeks. Most of these patients have no past medical history and were at home with either mild symptoms (or in two cases, no symptoms) of COVID-19," Dr Thomas Oxley, a neurosurgeon at Mount Sinai Health System, told CNN.
The cases will be published online in the New England Journal of Medicine on April 29. In the case series, one patient has died, one remains hospitalized, two are undergoing rehabilitation and one was discharged as of April 24.
A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die within minutes. In the current study, medical experts are describing them as large vessel strokes, which are deadly. It involves a blood clot that travels from the body into an artery in the brain.
"Three large US medical centers are preparing to publish data on the stroke phenomenon. There are only a few dozen cases per location, but they provide new insights into what the virus does to our bodies. The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke. Known as large vessel occlusions, or LVOs, they can obliterate large parts of the brain responsible for movement, speech, and decision-making in one blow because they are in the main blood-supplying arteries," says The Washington Post.
Dr Oxley told CNN that the average person who has a large vessel stroke is "severely impaired." "It means it is a bigger clot. It includes one of the largest arteries in the brain. The most effective treatment for large vessel stroke is clot retrieval, but this must be performed within 6 hours, and sometimes within 24 hours," he explained.
According to experts, while strokes have been observed in older COVID-19 patients, this new trend is disturbing as it involves younger patients who are not severely ill. "For comparison, our service, over the previous 12 months, has 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," says the study, according to CNN.
Dr Oxley told Medscape Medical News it was surprising to learn that the virus appears to cause disease through a process of blood clotting. "The message for neurologists and other physicians is we're learning that this can disproportionally affect large vessels more than small vessels in terms of presentation of stroke," he said.
Dr J Mocco, a Mount Sinai neurosurgeon, has observed a similar trend. In the three weeks beginning mid-March, Dr Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period, reports Reuters. "Five were unusually young, under age 49, with no obvious risk factors for strokes, which is crazy. Very, very atypical. The youngest was only 31. At least half of the 32 patients would test positive for COVID-19," said Dr Mocco.
Dr Robert Stevens, a critical care doctor at Johns Hopkins Hospital in Baltimore, called strokes one of the most dramatic manifestations of the blood-clotting issues, the Washington Post reported. "We’ve also taken care of patients in their 30s with stroke and COVID-19, and this was extremely surprising," he said.
The experts also acknowledge that since the start of the coronavirus pandemic, patients may be unwilling to call emergency services for conditions that may not be related to COVID-19. The study says that two of the five cases in the series delayed calling an ambulance. "I understand why people do not want to leave the household. I think people are more willing to ignore other (non-COVID-19) symptoms in this environment," Dr Oxley told Medscape.