Doctors consider possible stroke and COVID-19 connection

Style Magazine Newswire | 5/18/2020, 12:49 p.m.

By American Heart Association News

The first thing to know about the possible links between COVID-19 and stroke is simple, say doctors: We just don't know.

"We have very serious worries that there's a connection," said Dr. Patrick D. Lyden, professor of neurology at Cedars-Sinai Medical Center in Los Angeles. "But I want to make it crystal clear that if we stay focused on evidence and data – which we really need to do more of at this moment – we don't know anything with probability."

Lyden, who wrote American Heart Association guidance for stroke centers about how to handle the coronavirus for its journal Stroke, said doctors anecdotally were reporting "a surprising number of very severe strokes at this time" in COVID-19 patients.

But the reason isn't clear. Many of those patients already had conditions such as high blood pressure and diabetes that made them stroke candidates. "So, the question is," he said, "is the virus somehow triggering a stroke in these folks who have the usual suspect risk factors?"

A second related worry, he said, is whether COVID-19 might be causing increased blood clotting, which could cause a stroke.

There have been reports of such strokes striking relatively young COVID-19 patients. The Washington Post highlighted such concerns, quoting doctors from several medical centers and a letter to the New England Journal of Medicine.

"I've seen that with my own eyes – otherwise healthy young people with COVID infection and a stroke," Lyden said. But he's not ready to declare a link. "I guess the right way to put it is, we've got our antenna up. We're looking and searching. There seem to be observations here that should worry a lot of us, but I'm not ready to say we know what we're talking about."

Dr. Thanh Nguyen, director of neuroendovascular service at Boston Medical Center and a professor of neurology, neurosurgery and radiology at Boston University School of Medicine, agreed that until evidence is stronger, it's too early to link COVID-19 to stroke.

Nguyen, lead author of guidance on interventional stroke treatment from the Society of Vascular and Interventional Neurology published in Stroke, said she had read the reports about stroke in young people. But she said the COVID-19 patients she'd seen with stroke had the usual vascular risk factors, such as hypertension, diabetes and the type of irregular heartbeat known as atrial fibrillation.

So, she believes "the jury is still out" on whether COVID-19 is causing stroke in younger patients or excessive clotting.

Excess clotting could be a result of inflammation caused by the virus, Nguyen said. It also could develop just from being bedbound and immobile. And if COVID-19 were causing such clotting, she'd expect to see more reports of problems related to it. To the contrary, she's "really seeing a drastic decrease" citywide in patients with minor strokes and the mini-strokes known as transient ischemic attacks. Though, that could be related to people avoiding the emergency room out of fear of catching the coronavirus.