Our understanding of COVID-19 evolves with each passing week of the global pandemic. This week, the Centers for Disease Control and Prevention (CDC) added six additional symptoms of the novel coronavirus to its growing list. With worldwide cases now surpassing 3 million, another concerning association has emerged: COVID-19 may increase risk of stroke in adults under 50 years old.

Emerging association between COVID-19 and young stroke

A physician group from Mount Sinai Hospital System in New York recently published a report concerning a two-week period in March in which five adults under age 50 presented with symptoms of acute stroke. All were subsequently diagnosed with COVID-19. This figure constitutes a greater than fivefold increase of large-vessel stroke in adults under 50 than seen in previous weeks within the hospital system.

On average, the five cases presented to the hospital with severe stroke (NIHSS = 17). Two of the five adults in this cohort had no significant medical history or known risk factors for stroke. Four of the five presented to the hospital eight or more hours after initial onset of stroke symptoms. A Mount Sinai physician who had worked with these patients stated that two reportedly delayed calling an ambulance.

How can COVID-19 cause a stroke?

It is thought that COVID-19 promotes vascular inflammation and increased blood coagulability, leading to blood clot formation. If a clot blocks a major artery, it can obstruct blood flow and cause tissue death in the form of a stroke or heart attack. Recent studies from the Netherlands and China have also noted an increased incidence of stroke and blood clotting-related complications among adult COVID-19 patients.

Worries about burdening the healthcare system or thoughts that "it can't happen to me" might have caused some of the Mount Sinai patients to defer medical attention. Their stories serve as a cautionary tale for other young adults navigating the pandemic: be prepared to recognize and respond to stroke symtoms during this time of elevated risk.

BE FAST to recognize stroke symptoms

Every second counts in recognizing a stroke, as a vessel-blocking clot can cause millions of brain cells to die per minute. The BE FAST acronym is any easy way to remember stroke symptoms and the need to take action. Memorize the information below, and know that one does not have to be experiencing all symptoms to be having a stroke.

Balance loss including unsteadiness, tripping, or falling
Eyesight changes like blurred vision, double vision, or vision loss
Facial drooping or inability to maintain a symmetrical smile
Arm weakness presenting as clumsiness or partial to total inability to move
Slurred speech including difficulty forming words or speaking altogether
Time to call 911!

Monitor COVID-19 symptoms and know the emergency warning signs

The CDC states that most cases of COVID-19 are mild and recommends monitoring symptoms of the condition. Individuals who are experiencing severe or concerning symptoms or suspect exposure to COVID-19 are advised to contact their healthcare provider immediately for further direction.

COVID-19 symptoms:

• Cough
• Shortness of breath
• Fever
• Chills
• Repeated shaking with chills
• Muscle pain
• Headache
• Sore throat
• New loss of taste or smell

The CDC also describes emergency warning signs of severe illness. If you are experiencing any of the symptoms below, call 911 immediately.

Seek medical attention for emergency warning signs:

• Trouble breathing
• Persistent chest pain or pressure
• New-onset confusion or difficulty to wake
• Blue-tinged lips or face

Always take an ambulance during an emergency

If you experience stroke symptoms or COVID-19 emergency warning signs, opt for ambulance transport to the hospital instead of self-transport. Delay in hospitalization during a medical emergency is associated with increased mortality across health conditions.

Research examining acute stroke patients' motives for self-transport to the hospital sheds light on why some defer calling 911. Subjects cited the desire to go to a particular hospital, not realizing the situation was an emergency, and belief that car transport would be faster among their reasons to drive themselves or get a ride.

Ambulance transport is the fastest and safest route to the hospital. Do not gamble with your prognosis or the lives of others on the road by taking a car. Although this advice is important for all age groups, it is increasingly relevant for adults under age 50. Knowing the symptoms and correct response to COVID-19-related emergencies can make the difference between life and death.

Further Reading:

How to Spot and Prevent Blood Clots
What to Do If You Have COVID-19 and When to Call 911