Does risk of stroke increase in people with COVID-19 infection?

Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)
Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)

We know COVID-19 affects different people in different ways. Most of the time the infection is mild with fever, cough, tiredness and loss of taste or smell. These individuals recover without hospitalization.

On average it takes five to six days when someone is infected with the virus for symptoms to show, however it can take up to 14 days. The incubation period ranges from 1 to 14 days. The median is 5 to 6 days between exposure and symptom onset.

Some individuals present with serious symptoms. The lungs are the organs most affected by COVID‐19. Symptoms like difficulty breathing, loss of speech, difficulty walking, confusion and chest pain are not uncommon. These individuals need to seek immediate medical attention.

Patients with COVID-19 infection can have neurological problems as well including stoke. This happens because of the change in the thickness of the blood called hypercoagulability. This may predispose an individual to stroke. Hypercoagulability is defined as the tendency to have thrombosis (blood clots) as a result of certain blood defects. Clinical manifestations of hypercoagulability can be devastating and even lethal.

Recently, researchers have found falling rates of new ischemic stroke admissions in hospitals, probably due to social consequences of the pandemic: fear to be infected or not adequately treated in the hospital. This phenomenon is of concern.

In one of the largest studies of its kind to date, published Aug. 14, 2021, in The Lancet (What is the association of COVID-19 with heart attacks and strokes?) researchers found strong evidence that heart attack and stroke risk rises sharply in the weeks following a COVID-19 diagnosis.

In the week after a COVID-19 diagnosis, the risk of a first heart attack increased by three to eight times. The risk of a first stroke caused by a blood clot multiplied by three to six times. In the following weeks, both risks decreased steadily but stayed elevated for at least a month.

Other bacterial and viral infections (such as influenza) are known to temporarily boost rates of heart attacks and strokes. But COVID-19 infections appear to be especially risky, perhaps because they trigger an exaggerated inflammatory response that makes blood clots more likely.

There are two factors responsible and dangerous to the production of strokes. First factor — COVID-19 infection creates inflammation throughout the body. Second factor — it also produces hypercoagulation of the blood that makes the blood to clot easily than normal.

There may be somebody you know who has had a stroke usually without a warning. There are various causes of stroke: 85 per cent are ischemic strokes, which are caused by a blood clot in an artery. Obesity, diabetes, high cholesterol, irregular heart rhythm, smoking, drug abuse and many other risk factors are all linked to an increased likelihood of a stroke. Now we can add COVID-19 to the list.

Outcome of a stoke can vary. Ten per cent of the people recover fully. Thirty per cent of the people recover with minimal of physical and mental deficiency and 60 per cent of the people have major paralysis and end up in a nursing home.

You should seek immediate medical attention if you see somebody exhibits sudden loss of balance and coordination, has trouble seeing out of one or both eyes, face drooping or lop-sided, shows weakness of one arm and speech is slurred then call 9-1-1 right away. Time is of the essence to start tPA therapy.

tPA is short for tissue plasminogen activator and can only be given to patients who are having a stroke caused by a blood clot (ischemic stroke). It can stop a stroke by breaking up the blood clot. It must be given as soon as possible and within 4.5 hours after stroke symptoms start.

You may be familiar with the acronym F.A.S.T. to help you recognize a stroke. F – is the face drooping? A – can the person raise both arms? S – speech slurred? T – time to call 9-1-1.

Take care and be safe. And remember mask, distance and vaccination.

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