Connections: COVID-19 increases risk of ischemic stroke | Winter 2021

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From OHSU Brain Institute

Dr. Helmi Lutsep

Helmi Lutsep, M.D.

Dr. Lutsep is the interim chair and professor of neurology at OHSU. Her research focuses on the use of devices in stroke treatment. Additionally, she is the editor-in-chief of the neurology textbook eMedicine from WebMD and is a senior consulting editor for the journal Stroke.

Severe COVID-19 infections produce more blood clots than other virus-related illnesses, raising the risk of ischemic stroke. The systemic inflammation associated with the virus contributes to clotting and myocarditis.

Among patients hospitalized for COVID-19, about 25 percent have new onset of heart failure. Most data suggest that the patients most likely to experience these issues are already symptomatic with COVID-19 and have additional risk factors related to comorbidities, age and general health. However, stroke events with the new coronavirus are not limited to this sicker population.

Some asymptomatic young adults are having strokes as their initial symptom of a COVID-19 infection.

Stroke education for all ages to BE FAST

We teach our patients with an elevated risk of stroke to be aware of typical stroke symptoms, but our younger patient population may not recognize that numbness in the hand or blurred vision could be an emergency requiring immediate attention.

As always, time is brain in stroke. Since nationwide data suggest people are avoiding medical treatment due to fears of the new coronavirus, we need to emphasize to patients and caregivers that the earlier we can treat stroke, the better the outcome.

BE FAST responding to a stroke - watch for balance, eyes, face, arm, speech, and time

Managing risk factors

At this point, the spectrum of reaction to COVID-19 is still unpredictable — why does one person bounce back, and others do not?

We do know that inflammation and blood clots are a strong possibility with a COVID-19 infection. Our best practice as clinicians is to manage stroke risk factors as well as possible, so that whether or not patients contract the virus, the risk of stroke is lessened.

Hypertension is the no. 1 risk factor for stroke every day of the year, so encouraging patients to monitor blood pressure and lifestyle factors for their overall health will also help them in the event of a COVID-19 infection.

Studies consistently show how exercise is some of the best medicine available for preventing stroke — 30 minutes a day on most days, even if broken into smaller time increments.

When to refer

Through the OHSU Telestroke Network, we try to see as many acute stroke patients as possible.

If you have a patient who had a stroke for unclear causes or for whom management is uncertain, we are happy to evaluate the patient to determine the etiology and attempt to prevent further events.

Contact us

The OHSU Brain Institute is your partner in diagnosing and treating all neurologic disorders.

To speak with one of our clinicians, please call the OHSU Physician Advice and Referral Service at 503-494-4567. To refer a patient, please fax to 503-346-6854.