Why Strokes Tied to COVID-19 Might Be Affecting Young People More

Here’s what you need to know.

By Erin Hays
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Doctors Report COVID-19 Can Cause Sudden Strokes in Young Adults (1:26)

UPDATE: This article has been updated with new information on September 16, 2020 - 3 p.m. EST.

Contrary to popular belief, young people like myself don’t believe we are invincible. We worry about our job marketability, if we are saving enough for retirement, and global warming. One thing most of us don’t worry about: having a stroke. However, that might change soon. Unfortunately, recent reports show COVID-19 appears to be causing sudden strokes in young adults, mainly in their 30s and 40s. Usually these types of strokes affect those in their 70s. This represents a new development in the ever-changing landscape of the novel coronavirus pandemic, and also a new healthcare challenge to alert young adults about this symptom and teach them how to respond.

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At the beginning of the outbreak, COVID-19 was thought to mainly affect the lungs, causing the telltale symptoms of cough, fever, and shortness of breath. However, as doctors and scientists analyzed more data, they discovered the virus can affect almost every organ system in the body, including the heart and kidneys, among others. How exactly the virus affects these systems is still being studied, but new patterns seem to emerge every day.

In April the pattern was strokes. Previously, there was one report out of Wuhan, China that showed some association between COVID-19 and strokes, but it was more of a “hunch.” Then, more cases occurred.To document this, in April, five cases of young patients with COVID-19 presenting with stroke were published in The New England Journal of Medicine. According to Dr. Thomas Oxley, a neurosurgeon at Mount Sinai Health System in New York, the five people they have treated for strokes were all under the age of 50 and had either mild symptoms of COVID-19, or no symptoms at all. “Our report shows a seven-fold increase in 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,” Dr. Oxley told CNN on Apr. 22, 2020. He elaborated that two of the patients delayed calling an ambulance.

A stroke occurs when the blood supply to your brain is interrupted, either by a blood clot or a bleed in the brain. This interruption prevents your brain from getting the oxygen and nutrients it needs to survive and can lead to the death of brain cells. Most of the strokes seen as a result from COVID-19 have occurred when a blood clot forms in a vessel supplying blood to the brain. If the clot is not removed right away, damage can occur to the brain that can leave the patient with permanent impairment.

Researchers suspect the strokes related to COVID-19 may be a consequence of blood-clotting issues caused by the virus that are producing clots all over the body. These clots can travel through the blood vessels to the brain, causing a stroke. 

But Why is This Happening to Young People & How Can It Be Prevented? 

One theory reported by The Washington Post from assistant professor of neuroradiology at NYU Langone, Eytan Raz, is that young people are more resistant to the respiratory distress than older patients, “so they survive the lung side, and in time develop other issues.” One striking aspect of the case studies on the COVID-19 stroke patients is how long some waited before seeking emergency care.

According to data from the New England Journal of Medicine, one of Dr. Oxley’s patients was a 37-year-old male with no risk factors for stroke who experienced difficulty swallowing and speaking, a reduced level of consciousness, and weakness on his right side; he waited 16 hours before going to the hospital. When he got there, his scans showed a clot in one of the main arteries supplying the brain. This man had been experiencing no symptoms of COVID-19 infection, but had previously been exposed to a family member who had tested positive. He tested positive for COVID-19 in the hospital. 

Another 33-year-old female patient had a cough, chills, and a headache for about a week. Then, over a period of 28 hours, she noticed her speech was slurring and that her left side was growing weak and numb. However, she delayed seeking care due to fears over the COVID-19 outbreak. By the time she reached the hospital, tests showed she had two clots in her brain and her COVID-19 test came back positive.  

Luckily, in both of these reported cases, therapy worked and both patients were discharged. However, others with similar symptoms are still hospitalized and struggling. 

As seen in these instances, strokes can be treatable if they are caught in time. It is important to seek medical attention immediately if you notice any signs or symptoms of a stroke. A good acronym to remember is FAST:

Face: Ask the person to smile. Does one side of the face droop?

Arms: Is the person able to raise both arms. Is one arm not able to raise or does it drift downward?

Speech: Can the person repeat a simple phrase? Is their speech slurred or strange?

Time: It is imperative if you notice any of these signs to call 911 immediately.

While some of this new information about COVID-19 may sound scary, it is important to remember that only a small number of patients are seeing these particularly severe side effects of the virus. However, staying informed is important so you know if and when you need to seek medical attention.

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Article written by Erin Hays