In the early months of the pandemic it became clear that the elderly and those with comorbidities were going to be hit the hardest. For many young adults, there was a sense of immunity, evidenced in places like Florida where spring breakers continued to flock.
It was also during this time that neurologists began seeing an odd increase in young, healthy adults having massive strokes.
“We had to really start thinking about the possibility of COVID in patients, even if they didn’t necessarily have the classical respiratory symptoms,” Dr. Jaime Hatcher-Martin, a neurologist with SOC Telemed, told us. “We had to consider that as a possible etiology for strokes and hemorrhages, especially in patients that were younger and those that didn’t have any other risk factors.”
“The strokes that were coming to people’s attention were people who really didn’t have tons of risk factors otherwise,” added Dr. Elaine Jones, another neurologist working for the same company. “They were surprising given their history and age, so we felt it was related to COVID.”
Stroke in young people was also mentioned in a systematic review of neurological complications related to COVID-19. That review was published in May 2020 in the journal of Neurological Research and the authors advised that young adults with unexplained and unexpected strokes should be tested for SARS-CoV-2 infection.
A case study published in the August 2020 edition of the Journal of Stroke and Cerebrovascular Disease serves as “typical presentation of COVID-19 in the young.” A 29-year-old female with no comorbidities and no significant past medical history was treated for a cerebral venous thrombosis.
“Further questioning revealed a one-week history of headaches, low-grade fever, mild cough and shortness of breath, diagnosed as COVID-19,” write the authors. “Although elderly patients with comorbidities are considered highest risk for COVID-19 neurologic complications, this case report emphasizes that young individuals are at risk for VTE with neurologic complications even when systemic symptoms are mild, likely induced by COVID-19-associated hypercoagulable state.”
These are early days in terms of understanding these strokes and their exact relationship to COVID-19, doctors say.
“We are still working through that data to see what it is,” said Jones. “Some of it we think is inflammation of the vessels, some are hypercoagulable, having a tendency to clot. Patients certainly had both microclots and microbleeds in their lungs so that was affecting their brains as well, and sometimes the brains were affected first.”
Martin mused about a “sort of domino effect or this cascade of things that happens.” Not a direct A causing B but rather “A causes B, causes C, causes D. But the inciting event is the coronavirus, or SARS-CoV-2.”
Both Jones and Martin agree that because of COVID-19, the threshold for suspicion of stroke in otherwise young and healthy people has been lowered, and it has made them more vigilant. Hopefully this vigilance gets passed on to the community at large – and young people get the message.
Special thanks to the following neurologists for their insights on this issue: