Faculty Members Note Link Between COVID-19 and Stroke

“We’re seeing an increased percentage of younger, typically female, stroke patients,” says Elad I. Levy, MD, the L. Nelson Hopkins III, MD, Professor and Chair of neurosurgery.

Based on conversations he has had with medical colleagues at hospitals in and around New York City, Levy says there could be an increase of up to 20 percent of stroke incidence during the apex of the coronavirus pandemic.

This is surprising, because the novel coronavirus has been seen as primarily a respiratory illness, like influenza. But it is becoming increasingly evident that COVID-19 can affect the kidneys, heart, intestines, liver and brain, in addition to the lungs.

In a stroke, a clot that has formed in a blood vessel breaks off and travels through the circulatory system to the brain.

Levy says that patients in the newly recognized stroke subgroup typically show up at the emergency department with stroke symptoms, and usually have not been tested for the virus. Emergency stroke treatment is initiated as tests are sent, and after the patients are treated, coronavirus results show up at a later time.

The reasons for the coincidence of stroke and COVID-19 are still unclear.

“That is the billion-dollar question,” says Levy, who also serves as medical director of neuroendovascular services at Gates Vascular Institute.

Levy says one possible reason is because these patients have fevers and are dehydrated, which causes the blood to thicken. In addition, pre-existing conditions — such as obesity, smoking and an increasing sedentary lifestyle during quarantine — are “factors that enhance every single risk factor for stroke.”

This new type of stroke patient requires new treatment protocols in the hospital, Levy says. They need to be kept in a dedicated room so as not to infect other patients in the stroke ward. In addition, medical staff need to have dedicated personal protective equipment and intubation equipment.

Once they are stabilized, these patients are put through a battery of tests.

Levy and his colleagues in Western New York are collecting as much information as they can on all stroke patients who test positive for COVID-19. 

“There are many questions we need to ask,” Levy says.