BREAKING! Strokes And COVID-19: Researchers Warn Emerging High Rates Of Unexplained Strokes Linked To COVID-19
Source: Strokes And COVID-19 Sep 22, 2020 4 years, 3 months, 15 hours, 52 minutes ago
Strokes-COVID-19: It is already being reported by medical professionals all over the world about a sudden increase of unexplained strokes in the last few months. Among those that were already tested positive for COVID-19 but were either asymptomatic or had recovered from severe, moderate or even mild conditions of the SARS-CoV-2 infection, the risk of strokes was found to be high but there are many out there who do know even know that they had contracted COVID-19 and were never even tested.
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For this case series study that explored the association of COVID-19 and acute ischemic stroke, scientist from Emory University Hospital observed higher than expected rates of unexplained or "cryptogenic" strokes, as well as delays in stroke presentations or symptom recognition.
The study results were published in the peer reviewed journal: PLOS ONE.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239443
Typically an ischemic stroke is caused by a clot that blocks blood flow to the brain and is the most common form of acute stroke.
However in some instances, despite looking for causes of these strokes by a thorough cardiac evaluation (heart conditions are one of the most common causes) or by looking at blood vessels supplying the brain or by testing for increased blood clotting conditions, the cause cannot be determined.
The research looked at COVID-19 patients with ischemic stroke from the Emory University Hospital system.
From a total of 396 ischemic stroke patients admitted during the study period from March to July 2020, 13 were diagnosed with COVID-19 on admission.
The study team found the occurrence of stroke greater in COVID-19 patients who had risk factors like diabetes, hypertension, hyperlipidemia or atrial fibrillation/flutter.
Males and African Americans were predominantly affected by strokes in the study.
The study team said it was observed that of the 396 ischemic stroke patients admitted during this study period, 13 (2.5%) were also diagnosed with COVID-19. The mean age of patients was 61.6 ± 10.8 years, 10 (76.9%) male, 8 (61.5%) were Black Americans, mean time from last normal was 4.97 ± 5.1 days, and only one received acute reperfusion therapy. All 13 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic with 4 explained by atrial fibrillation. COVID-19 patients had a significantly higher rate of cryptogenic stroke than non-COVID-19 patients during the study period (69% vs 17%, p = 0.0001).
Dr Dinesh V. Jillella, Assistant Professor of neurology, Emory University School of Medicine
"Interestingly, while cryptogenic strokes typically account for only 10 to 30% of all strokes, in our study we found it in 69% of the patient population which is extremely high and suggests the possibility of COVID-19 as a likely contributory factor in this presentation."
Dr Jillella says that
compared with the patients who did not have COVID-19, this was a statistically significant difference
of 69% of strokes of cryptogenic etiology in the COVID-19 ischemic stroke group compared to only 17% in the non-COVID ischemic stroke group.
Dr Jillella added, "One of the most important findings from our study also pertains to the delayed recognition of stroke symptoms either due to delays in presentation or recognition of symptoms.”
The research observed a prolonged average amount of time to presentation and symptom recognition averaging up to five days, a potential impact of the COVID crisis.
Unfortunately such delays limited the use of acute reperfusion treatments, including drugs and surgery, to restore blood flow in or around the blocked vessels which can only be used when patients present within a 24-hour period.
The study explained that delayed presentations could be a result of patients waiting longer before coming to the hospital due to self-isolation or quarantine precautions or the fear of contracting COVID that have led to a general decline in acute stroke evaluations across the country.
Dr Jillella says study findings, therefore, highlight the need for increased community awareness/education regarding the urgency of stroke symptoms and the need to ensure rapid evaluation to facilitate early stroke treatments.
Furthermore since patients with COVID admitted to the hospitals are generally sick and might not be able to express their symptoms well, it is very difficult to identify some of the subtle and atypical stroke symptoms by the physicians/health care workers especially when such patients are also intubated (on respiratory support), needing the hospital staff ie clinicians, nursing staff or associated personnel to be hypervigilant about any changes of patient status.
These findings support the idea that the hypercoagulable (increased clotting) state from COVID could contribute to stroke presentations and also show the issues with regards to delayed presentations and symptom identification in the setting of COVID.
However of note, even though COVID causes a hypercoagulable state and can contribute to clot based strokes, it should be noted that only 2.5% of the ischemic stroke hospital admissions constituted COVID related ischemic strokes, which is a relatively small number.
Dr Jillella says the findings from the study need to be confirmed in larger multicenter studies since this is a preliminary case series and is based on observations from a single medical system.
Dr Jillella added, "We have been extra vigilant with regards to patients coming in with COVID-19 symptoms, and for identification of any stroke features in them. Hospital protocols have been modified to ensure appropriate blood thinner usage is done based on the current updated national guidelines since it is being shown in multiple studies that COVID related hypercoagulable state can contribute to strokes directly."
Patients with COVID-19 symptoms and their next of kin are being educated regarding the urgent need to get help and be evaluated if any concerning symptoms of a stroke are identified.
However out of hospital settings, they are lots of individuals suffering fatal strokes and this is another segment that needs to be studied.
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