Coronavirus 2019 (COVID-19) has caused a shift in the landscape of stroke regarding age. Young people, that is persons under 50 years old, can have a stroke as the only symptom of COVID-19. Not cough or fever. Stroke is the third leading cause of death and the number-one cause of disability in the United States. Worldwide, 15 million persons suffer from a stroke annually. High blood pressure, known as hypertension, contributes globally to 12.7 million strokes. Indeed, hypertension is the number-one modifiable risk factor for stroke. In Jamaica, one in three persons has hypertension. Therefore, Jamaicans are at high risk for stroke. Age is the greatest risk factor for stroke, but, to date, this is not modifiable. The older you are, the more likely you are to have a stroke. However, COVID-19 has caused a change, because perfectly healthy young people who have COVID-19 are having strokes.
Mount Sinai Health System in New York reported that, during the initial spike in COVID-19 cases, most of the stroke patients that required interventions were young persons with clogged arteries. The vessels that transport blood in the brain spontaneously became clotted. COVID-19 causes inflammation of the inner lining of the blood vessels, and the blood also becomes ‘sticky’ or hypercoagulable. When this happens, blood does not flow easily through the blood vessels, and this prevents oxygen and other nutrients from reaching the organs. This problem with blood flow can also lead to clots in the legs, lungs, and cardiac vessels. Therefore, it has been recommended that healthy, young persons who present with stroke during the pandemic should be tested for COVID-19.
Initially, the neurological effects of COVID-19 were unrecognised, because it was considered a respiratory illness. But, in fact, like Zika and dengue, COVID-19 also affects the nervous system. Human coronaviruses, including COVID-19, have the ability for neurotropism, which means the virus has an affinity for nerve tissue. The nervous system is composed of the brain, spinal cord and the peripheral nerves which travel from the spinal cord to the various muscles and organs in the body. There are essentially two periods of time when COVID-19 may affect the nervous system: during the acute phase of the illness and as part of the post viral syndrome when the virus is no longer detected. Either way, neurological problems as a result of COVID- 19 can be permanent or incompletely resolved, resulting in long-term deficits or disabilities.
Here are the cold hard facts-
• About half of hospitalised patients with COVID-19 have neurological manifestations of COVID-19, including headache, dizziness, cognitive impairment, loss of smell and taste, seizures, strokes, and weakness.
• One third of hospitalised COVID-19 patients have encephalopathy or injury to the brain, which may cause confusion and altered mental state. Such persons stay in the hospital three times longer than patients who do not have encephalopathy and have significantly worse outcomes. Two thirds of these patients cannot take care of themselves when discharged from the hospital.
• Anosmia, which is the loss of smell, is the main neurological symptom in COVID-19 patients, and one of the most common presentations. It is actually a better predictor of infection by the virus, compared to fever and cough. This means, if you suddenly lose your sense of smell, it is highly probable that you have COVID-19. Ageusia – the inability to taste, is also a common symptom. Anosmia and ageusia may be the only symptoms of COVID -19 a person may have, especially if they are paucisymptomatic. This simply means, presenting with few symptoms.
In October 2020, the British Medical Journal (BMJ) reported a case of permanent hearing loss in a COVID-19 patient whose symptoms began a week after he left the hospital, and six months later still had the deficit. Some patients with COVID-19 experience hearing loss and tinnitus (ringing in the ear).
Dr Igor Koralnik, Northwestern Medicine chief of neuro-infectious diseases and global neurology, has formed a new outpatient ‘Neuro-Covid Clinic’, to determine if the neurological disorders are temporary or permanent. Imagine that there is now a clinic dedicated solely to patients who have neurological complications as a result of COVID-19.
That is why, when persons say COVID-19 is not causing a lot of deaths in Jamaica, they need to understand that, even if you have been asymptomatic, it can eventually result in stroke and other neurological deficits which may potentially have lifelong effects. So, please, try to do all that you can to avoid contracting this virus. Think twice or even thrice, before deciding to go out and socialise this holiday season. Is it worth possibly getting these neurological illnesses? In Jamaica, it is against the law to drive if you have epilepsy. Your livelihood may be jeopardised.
Remember that the number of reported cases presented by the Ministry of Health (MOH) does not represent the actual number of persons infected with COVID-19. On November 26, 2020, the total reported cases were 10,541. Some models indicate that this number should be multiplied by 30 to 70, to determine the actual number of COVID-19 infections. Therefore, 10,541 multiplied by 70 means that 737,870 persons may have COVID-19 in Jamaica. In other words, we are approaching almost 1 million people in Jamaica having COVID-19. Consequently, there will be many people with neurological problems, and this will be a tremendous burden on Jamaica’s health system, not to mention the economic impact. If the death count does not alarm you, then subsequent health complications, of which neurological effects are only one of many, should.
These are signs of a stroke:
1. Sudden onset of numbness or weakness in the face, arms, or legs.
2. Sudden onset of slurred speech or difficulty understanding people speaking to you.
3. Sudden loss of vision in one or both eyes.
4. Sudden onset of dizziness or poor coordination.
5.Sudden onset of difficulty walking.
If you experience any of these symptoms, even for a few minutes, please seek immediate medical attention.
Dr Michele Lee Lambert is a neurologist, board certified by the American Board of Psychiatry and Neurology. She is the medical director of Caribbean Neurology Pain and Headache Center and currently provides telemedicine for patients.