Research suggests an association between COVID-19 and stroke.

There have been several reports in the media about a potential link between stroke and COVID-19, especially in younger people.

This article looks at the evidence to date and offers advice and information on what to do if someone has symptoms of either COVID-19 or a stroke.

an older person is talking to a healthcare worker, who is wearing a face mask, gloves, and a white jacketShare on Pinterest
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So far, research seems to indicate that COVID-19 may increase the risk of having a thrombotic vascular event, or thrombosis. Thrombosis occurs when a blood clot forms and blocks a blood vessel, such as an artery or a vein.

Blocking blood flow can cause several serious complications, including:

  • heart attack: when a blood clot blocks blood flow to the heart
  • stroke: when a blood clot blocks blood flow to the brain
  • transient ischemic attack (ministroke): when a blood clot temporarily blocks blood flow to the brain
  • critical limb ischemia: when a clot blocks the blood supply to a limb
  • pulmonary embolism: when a clot blocks the blood flow into the lungs

Studies have found that people who have SARS-CoV-2, the virus that causes COVID-19, develop abnormal blood clotting as an inflammatory response to the virus. This increases the risk of blood clots forming. If a blood clot blocks an artery to the brain, it causes a stroke.

As research continues, experts are discovering more about which people with COVID-19 are more likely to have a stroke. According to the UK Stroke Association, these include:

  • people with underlying health conditions that affect their heart and blood vessels, such as hypertension, diabetes, and heart disease
  • people with severe symptoms of COVID-19
  • people of Asian ethnicity

According to a 2020 article, people with COVID-19 are 7.6 times more likely to have a stroke than people with influenza.

Another 2020 article records that in areas with a high concentration of people with COVID-19, hospitals and healthcare teams are reporting stable or increased incidences of stroke that appear to have no typical cause.

Recent studies show that people with severe cases of COVID-19 are more likely to have a stroke, compared with people who have milder symptoms. In a 2020 Wuhan study, researchers found that almost 6% of people with severe infections had neurological complications, including stroke, compared with less than 1% of people with nonsevere infections.

Research also shows that stroke affects younger people with COVID-19. Three separate studies from New York, Paris, and New York and Philadelphia show that people with COVID-19 who have a stroke are significantly younger than people without COVID-19 who have a stroke, by as much as 15 years.

However, the UK Stroke Association points out that older people with COVID-19 are still much more likely to have a stroke than younger people with COVID-19.

According to the Centers for Disease Control and Prevention (CDC), these are the major signs and symptoms of stroke, all of which come on suddenly:

  • numbness or weakness in the face, arm, or leg, especially on one side of the body
  • confusion, difficulty speaking or understanding speech
  • difficulty seeing from one or both eyes, dizziness, loss of balance or coordination
  • severe headache

Acting F.A.S.T. can help a person having a stroke get the treatment they need as soon as possible. People who are helping someone who may have had a stroke should follow these instructions:

  • F – Face: Ask the person to smile and check if their face droops to one side.
  • A – Arms: Ask the person to raise both arms and check if one arm drifts downward.
  • S – Speech: Ask the person to repeat a simple phrase and listen for slurring or difficulties.
  • T – Time: Save time and act quickly by contacting emergency services immediately.

If the symptoms disappear after a time, it remains important to seek medical advice to rule out a ministroke.

According to the CDC, the following symptoms may appear 2–14 days after exposure to COVID-19:

  • fever or chills
  • cough
  • shortness of breath or difficulty breathing
  • fatigue
  • muscle or body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting
  • diarrhea

People with suspected COVID-19 infections should call their doctor, or visit their state or local health department’s website, for information on testing. People who do not have a doctor should contact their nearest community health center or department.

A person with the following symptoms should seek emergency medical attention:

  • breathing difficulties
  • pain or pressure in the chest that does not go away
  • confusion
  • inability to wake or stay awake
  • pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

Note that health agencies and scientists around the world are continually revising symptoms of COVID-19 as research advances. People should stay abreast of updates.

Experts have noted that all stroke survivors and people with neurological conditions, such as dementia, are more vulnerable to becoming seriously ill with COVID-19.

This may increase their risk of:

  • being hospitalized
  • needing care in the ICU
  • being intubated or having mechanical ventilation
  • death

The effects of the pandemic may mean that some people in hospital for a stroke may leave earlier than usual. They may also have problems accessing care acutely (during the stroke) or after leaving the hospital. This may affect services such as rehabilitation resources, such as physiotherapy and neurorehabilitation therapy.

However, they should still get the support and treatment they need from their healthcare team or stroke center, with a detailed care plan. Some treatments may need to happen at home, while appointments may happen over phone or video calls.

Stroke survivors are vulnerable to severe COVID-19. That means survivors, and those who care for them, should take extra precautions and care in maintaining hygiene and physical distancing. Washing hands and cleaning surfaces and items that others have touched is important. A stroke survivor may also wish to get a COVID-19 vaccine.

Health experts also advise staying at home whenever possible. Stroke survivors may wish to ask a family member or friend to undertake essential tasks outside the home, such as grocery shopping or pharmacy trips. They should also work from home where possible and avoid situations in which physical distancing is difficult to maintain.

Wearing a mask helps to protect you and others around you. Stroke survivors should wear a mask when venturing outdoors and avoid anyone not wearing one.

People who have a history of stroke or strokes should continue to take their medication and talk to their healthcare team about how they can safely continue to have their regular checks.

Anyone who has symptoms of a stroke should contact emergency services immediately. Hospitals have developed strict protocols and procedures to protect incoming people from COVID-19.

COVID-19 may increase the risk of stroke in certain groups. The presence of the pandemic may also increase the risk of complications and severe illness in stroke survivors, regardless of the cause of their stroke.

Knowing the symptoms of COVID-19 and the symptoms of stroke will help people get the treatment they need faster. Individuals should never delay getting emergency medical care because of COVID-19.