The Stroke-Covid Link: Understanding The Potential Risk

COVID-19 is a complex disease with pathways that are only just beginning to be understood. While it is primarily a respiratory illness, it can also affect other organs in the body. Research has found a link between COVID-19 and an increased risk of stroke, with one study suggesting that the risk is highest within three days of a COVID-19 diagnosis and can remain high for months. This is thought to be caused by the inflammatory response to the virus, which can lead to blood clots that could cause blockages in the brain. However, the exact causes of brain-related issues are unclear, and more research is needed to fully understand the relationship between COVID-19 and stroke risk.

COVID-19 and clotting

COVID-19 is a novel virus that has infected millions of people worldwide. It is known to cause respiratory issues, but it can also lead to an increased tendency for blood clotting. Blood clotting is a well-recognised complication of SARS-CoV-2 infection and has been observed in both deep veins and arteries, sometimes leading to strokes and heart attacks.

The Link Between COVID-19 and Blood Clotting

The connection between COVID-19 and clotting was first recognised during the early stages of the pandemic among hospitalised patients. Those with severe COVID-19 symptoms were found to be at a higher risk of developing blood clots, but people with non-severe illness have also been affected. Research indicates that the overall incidence of blood clotting among people with COVID-19 is about 14%, rising to 22% for those treated in intensive care.

Why COVID-19 Causes Clotting

One theory suggests that the clotting observed with COVID-19 is a result of the body's immune reaction to the virus. When fighting the virus, the body undergoes an inflammatory response, which can also cause inflammation in the blood vessels, leading to clotting. This major inflammatory response is particularly evident in people who are critically ill with COVID-19 and requires hospitalisation, ventilation, or intensive care.

COVID-19 Vaccines and Clotting

It is important to note that while COVID-19 infection can increase the risk of blood clotting, the COVID-19 vaccines are safe for those with a history of blood clots. The Moderna and Pfizer-BioNTech mRNA vaccines have not been shown to increase the risk of blood clots in multiple studies. However, two other COVID-19 vaccines, AstraZeneca and Johnson & Johnson, have been linked to an extremely rare syndrome called vaccine-induced thrombotic thrombocytopenia (VITT), which can cause both low platelet counts and blood clots.

Recognising the Signs of a Stroke

It is crucial to be able to recognise the signs of a stroke and act quickly. Use the acronym BEFAST to remember the most common stroke symptoms:

• Balance: Sudden loss of balance or coordination
• Eyes: Sudden trouble seeing out of one or both eyes
• Face: Is the face drooping or numb? Does the person's smile look uneven or lopsided?
• Arm Weakness: Is one arm weak or numb? Does one arm drift down when raising both?
• Speech: Is speech slurred? Is the person unable to speak or difficult to understand?

If you or someone you know is experiencing any of these symptoms, call emergency services immediately. Time is of the essence when it comes to treating strokes.

COVID-19 and inflammation

COVID-19 has been found to cause inflammation in the body, which can lead to an increased risk of blood clots, heart problems, and stroke. The virus can also affect the vascular lining and increase the risk of blood clots in large blood vessels and small vessels, particularly in the heart and lungs. This inflammation and the blood clots can lead to poor oxygen levels in these organs, causing them to work harder and potentially fail.

A recent study published in Nature found that the virus might activate inflammasomes, large molecules that trigger a cascade of inflammatory responses that end in cell death. The study also found that certain antibodies developed during SARS-CoV-2 infection, but not following mRNA vaccination, can sometimes lead to more severe inflammation. These antibodies may coat the virus, making it easier for cells with the CD16 receptor to take it up and potentially worsening inflammation.

Another study found that COVID-19 could increase the risk of venous and arterial thromboembolisms, which are blood clots that can lead to heart attack and stroke. The risk of stroke is particularly high during and immediately after a COVID-19 infection, but the long-term effects are still being studied. People with multiple risk factors for stroke are more likely to experience a stroke during a COVID-19 infection.

COVID-19 has also been linked to an increased risk of deep vein thrombosis (DVT), which is a blood clot that usually forms in the legs. This clot can travel to the lungs and cause a life-threatening pulmonary embolism. The virus can also cause heart attacks, cardiac disease, and affect blood vessels directly.

Inflammation caused by COVID-19 can also lead to myocarditis, or heart muscle inflammation, which can manifest as heart failure or arrhythmia. This condition can be caused by direct damage from the virus or the indirect effect of inflammatory proteins released into the bloodstream. Myocarditis is often mild and self-resolving, but it can lead to long-term problems such as heart failure and rhythm abnormalities.

Overall, the inflammation caused by COVID-19 can have serious and potentially life-threatening consequences, including an increased risk of stroke. The risk of stroke is particularly high during and immediately after a COVID-19 infection, but more research is needed to understand the long-term effects.

COVID-19 and cardiac events

The novel coronavirus has been linked to an increased risk of heart and vascular problems, including strokes. Evidence shows that the virus has led to a rise in clotting events, particularly strokes, which the general population should be wary of.

The Link Between COVID-19 and Stroke

During the initial outbreak of COVID-19, it was believed that the virus primarily affected the lungs. However, as the pandemic progressed, physicians observed that the virus could also impact other organs, including the kidneys. Since the outbreak, there has been a notable increase in strokes among young and middle-aged people infected with COVID-19.

The exact nature of the connection between COVID-19 and stroke is still being investigated, but several factors are believed to contribute to the increased risk of stroke in COVID-19 patients:

• Infections and inflammation: COVID-19 is an infection that triggers a strong inflammatory response from the body, and inflammation increases the risk of stroke.
• Cardiac events: COVID-19 can trigger cardiac events such as heart attacks and dangerous heart rhythms, which are risk factors for stroke.
• Critical illness: COVID-19 can lead to multi-organ failure, including kidney failure, and being critically ill with multiple organ failures increases the risk of stroke.
• Clotting: COVID-19 appears to promote clot formation, and these clots can travel to the brain, causing a stroke.

A recent study reported a 7.6-fold increase in the odds of stroke with COVID-19 compared to the flu. The incidence of cerebrovascular disease in COVID-19 patients ranges from 1% to 6%, which could equate to a large number of individuals as the pandemic progresses. COVID-19 patients have also experienced an increased incidence of deep vein thrombosis (DVT), where a clot forms, usually in the legs, and may travel to the lungs, causing a life-threatening pulmonary embolism.

Another concerning trend is the occurrence of COVID-associated strokes in otherwise healthy young patients with no known risk factors. This has led to the theory that the increased incidence of strokes in COVID-19 patients may be due to a surge of inflammation and other body responses to the infection, causing the blood to form clots more easily.

The Importance of Timely Treatment for Strokes

It is crucial to seek immediate medical attention if you suspect you or someone else is having a stroke. Fast treatment can prevent death and long-term damage, and it reduces the risk of a second stroke. The most effective treatments for stroke are within a few hours of the stroke occurring. Unfortunately, due to the fear of contracting COVID-19 in hospitals, many people are delaying seeking medical care, often arriving too late to receive life-saving treatments.

Remember, your life depends on getting timely and appropriate medical intervention. Do not let the fear of COVID-19 stop you from seeking emergency care if you or a loved one is experiencing stroke symptoms.

COVID-19 and critical illness

COVID-19 has been linked to an increased risk of stroke, with recent studies showing a connection between the virus and blood clots, which can lead to strokes and heart attacks. This is particularly true for people with multiple risk factors for stroke, and those with moderate to severe COVID-19 symptoms. The risk of stroke is higher during and immediately after recovery from COVID-19, but the long-term effects are still being studied.

The Link Between COVID-19 and Stroke

The COVID-19 virus can cause inflammation throughout the body and hypercoagulation of the blood, leading to a higher risk of blood clots. These clots can then travel to the brain, causing a stroke. In addition, COVID-19 can trigger cardiac events such as heart attacks and dangerous heart rhythms, which are also risk factors for stroke. The virus can also lead to multi-organ failure, including kidney failure, which can further increase the risk of stroke.

Recognising Stroke Symptoms

It is important to be able to recognise the symptoms of a stroke and seek immediate medical attention. An easy way to remember the most common stroke symptoms is by using the acronym BEFAST:

• Balance (sudden dizziness or loss of balance)
• Eyes (sudden loss or changes in vision in one or both eyes)
• Face (a lopsided smile or facial weakness)
• Arm (difficulty raising both arms equally)
• Speech (trouble speaking)
• Time (call 911 immediately)

Other symptoms include trouble walking, a severe headache, and confusion.

Treatment Options for COVID-Associated Strokes

The treatment options for COVID-associated strokes are the same as for non-COVID-associated strokes. The main goal of treatment is to restore blood flow, and time is of the essence. People who present to the emergency department within four and a half hours are eligible for a clot-busting medication called tPA, and other potential treatments include clot retrieval through a specialised procedure.

Reducing Your Risk of Stroke

It is important to take care of yourself and manage any risk factors for stroke, such as high blood pressure and diabetes. This includes regular check-ins with your doctor, monitoring your blood pressure, adjusting your diet and activity level, and quitting smoking.

Hospitals and Stroke Care During COVID-19

Hospitals are taking precautions to keep patients safe during the COVID-19 pandemic. This includes screening patients and visitors for COVID-19 symptoms, separating COVID-19 patients from non-COVID-19 patients, and having healthcare workers wear personal protective equipment (PPE). It is important to seek medical attention immediately if you are experiencing stroke symptoms, as the fear of contracting COVID-19 should not outweigh the need for potentially life-saving treatment.

COVID-19 and clotting in the brain

COVID-19 has been linked to an increased risk of strokes, with research showing that the virus can cause blood clots, including in the brain. Blood clots can be life-threatening, but they are preventable and treatable if discovered early.

COVID-19 can cause inflammation throughout the body and hypercoagulation of the blood, a condition that makes blood clot more easily than normal. This can lead to the formation of blood clots, which can travel to the brain and cause a stroke.

Who is most at risk?

People with multiple risk factors for stroke are more likely to experience a stroke during COVID-19 infection. Those with moderate to severe COVID-19 symptoms are at risk, and doctors may recommend blood thinners to hospitalized patients. If you are not usually at risk for stroke and have mild COVID-19 symptoms, your risk of stroke may be low.

The long-term effects of COVID-19 on stroke risk are still being studied, but it is clear that the risk for stroke is higher during and immediately after recovery.

Recognising the signs of a stroke

It is important to be able to recognise the signs of a stroke and act quickly. Use the acronym BEFAST to remember the most common stroke symptoms:

• Balance: Sudden dizziness or loss of balance
• Eyes: Sudden loss or changes in vision in one or both eyes
• Face: Is the face drooping or numb? Does the person's smile look uneven or lopsided?
• Arm Weakness: Is one arm weak or numb? Does one arm drift down when raising both?
• Speech: Is speech slurred? Is the person unable to speak or difficult to understand?
• Time: If any of these symptoms are present, call 911 and get to a hospital immediately.

Treatment options for COVID-associated strokes

The treatment options for COVID-associated strokes are the same as for non-COVID-associated strokes. The main goal of treatment is to restore blood flow, and time is of the essence. People who present to the emergency department with stroke symptoms within four and a half hours may be eligible for a clot-busting medication called tPA. Other treatment options include clot retrieval through a specialized procedure performed by neuro-interventional radiologists, for those who present within 24 hours.

Frequently asked questions