Research suggests an association between COVID-19 and stroke in young adults. Read more on how the novel coronavirus could increase stroke risk, symptoms to recognize, and why you should always take an ambulance in the event of a medical emergency.

COVID-19 and Stroke in Young Adults: Know the Signs to Save a Life

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
[https://www.nytimes.com/2020/04/27/health/coronavirus-symptoms-cdc.html] 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 [https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=RP] 
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
[https://www.neofect.com/us/blog/what-is-the-national-institutes-of-health-stroke-scale-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
[https://www.cnn.com/2020/04/22/health/strokes-coronavirus-young-adults/index.html]
.



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
[https://www.thrombosisresearch.com/article/S0049-3848(20)30120-1/fulltext] and 
China [https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550025] 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
[https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html] 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
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464671/].

Research examining acute stroke patients' motives for self-transport to the
hospital [https://www.ahajournals.org/doi/10.1161/str.50.suppl_1.WMP93] 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
[https://newsinhealth.nih.gov/2017/01/how-spot-prevent-deep-vein-thrombosis]
What to Do If You Have COVID-19 and When to Call 911
[https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html]

COVID-19

COVID-19 and Stroke in Younger Adults: Know the Signs to Save a Life

A stroke is caused by either a blockage of a blood vessel or bleeding in or around the brain, which results in a lack of oxygen to the brain and the death of brain cells. 

What Are the Early Warning Signs of Stroke?



A stroke [https://www.strokeassociation.org/en/about-stroke] is caused by either
a blockage of a blood vessel or bleeding in or around the brain, which results
in a lack of oxygen to the brain and the death of brain cells.

Stroke is the fifth leading cause of death in the US, and the leading cause of
long term disability in the United States.

RECOGNIZE A STROKE
Learning to spot the signs of stroke can prevent or minimize disability. Just
remember the acronym F.A.S.T.

F: Facial Droop
Ask the person to smile. Is their smile crooked?

A: Arm Weakness
Ask the person to lift their arms. Does one arm drift downward?

S: Slurred Speech
Ask the person to say a simple sentence. Are they able to say the words clearly?

T: Time
If they have any of those symptoms, time to call 911 immediately. Every second
counts!

PRINT OUT THE PICTURE BELOW AND KEEP IT IN A VISIBLE SPACE


OTHER WARNING SIGNS



It's important to act fast and seek medical attention if you notice a facial
droop, arm weakness, or difficulty with speech, but there are other signs to be
aware of including:

 * numbness or weakness of a leg
 * confusion or trouble understanding
 * trouble seeing in one or both eyes
 * trouble walking, dizziness, loss of balance or coordination
 * severe headache with no known cause

DIFFERENCES IN GENDER



The above symptoms are the most common, but women can have different symptoms,
such as:

 * Loss of consciousness or fainting
 * General weakness
 * Difficulty or shortness of breath
 * Confusion, unresponsiveness or disorientation
 * Sudden behavioral change
 * Agitation
 * Hallucination
 * Nausea or vomiting
 * Pain
 * Seizures
 * Hiccups

WHY DO I NEED TO KNOW THE EARLY WARNING SIGNS OF STROKE?


It's important to know the early warning signs and get medical attention as
quick as possible. There are medications that can be given to break up a blood
clot and minimize the lack of blood flow to the brain. These medications are
effective if taken in the first 4 hours. Every second counts with a stroke.

If the medication is unable to break up the clot, a stent can be placed to allow
blood flow to return to the brain. If the stroke is caused by a hemmorage, there
are also several surgical options for treatment. The faster it can be addressed
the less damage to the brain is seen.

RECURRENCE OF STROKE AND PREVENTION
Having a stroke puts you at further risk for future strokes. It's important to
be aware of the early warning signs and to take active steps to preventing
future strokes.

PREVENTION STRATEGIES

 1. STOP SMOKING
 2. TAKE YOUR MEDICATION AS DIRECTED BY YOUR PHYSICIAN
 3. STAY ACTIVE!
 4. EAT FOODS WITH LOW CHOLESTROL, TRANS, AND SATURATED FATS
 5. DRINK ALCOHOL IN MODERATION

Check out more information on preventing another stroke.
[https://www.neofect.com/us/blog/how-can-i-prevent-having-another-stoke]

If you have had a stroke and are looking for an effective solution for your
stroke rehab [https://www.neofect.com/us/smart-glove] needs, please look into 
NEOFECT [https://www.neofect.com/us/smart-glove]'s line of Smart Rehabilitation
Solutions.

To learn more, please call (866) 534-4989 or email contactus@neofect.com.

References:

 * Benjamin, E. J. et al. (2019) Heart Disease and Stroke Statistics—2019
   Update: A Report From the American Heart Association
   [https://www.ahajournals.org/doi/10.1161/CIR.0000000000000659]. Circulation
   
   
 * Focht, K. L., Gogue, A. M., White, B. M., & Ellis, C. (2014). Gender
   differences in stroke recognition among stroke survivors
   [https://alliedhealth.ceconnection.com/files/GenderDifferencesinStrokeRecognitionAmongStrokeSurvivors-1412955098269.pdf]
   . The Journal of Neuroscience Nursing : Journal of the American Association
   of Neuroscience Nurses, 46(1), 18-22; quiz 22, E1-2. doi:
   http://dx.doi.org/10.1097/JNN.0000000000000026
   
   
 * Think FAST to recall the warning signs of a stroke. (2014, 04). Harvard
   Health Publications.Harvard Heart Letter, Retrieved from 
   https://www.health.harvard.edu/heart-health/think-fast-to-recall-the-warning-signs-of-a-stroke
   
   
 * https://www.stroke.org/we-can-help/survivors/stroke-recovery/first-steps-to-recovery/preventing-another-stroke/
   
   
 * https://www.stroke.org/understand-stroke/impact-of-stroke/women-and-stroke/
   
   
 * https://www.stroke.org/we-can-help/survivors/stroke-recovery/first-steps-to-recovery/preventing-another-stroke/
   
   
 * https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119