Dr. Sherry Chou, an associate professor of critical care medicine, neurology and neurosurgery, said reports have come in from all over the world that some COVID-19 patients are suffering strokes.
“In some cases, people are reporting that folks are coming in primarily with a neurological disorder, and then later on, because of some degree of suspicion, they tested them for COVID and found them to be positive,” Chou said. “Of course, as a medical community, we're both interested and concerned.”
Last week, the New England Journal of Medicine published a report summarizing the cases of five patients at Mt. Sinai Health System in New York City. All were under 50 years old, tested positive for COVID-19 and suffered large-vessel strokes within the same two-week period.
At least one Allegheny Health Network patient died after a COVID-related stroke. Sixty-four-year-old Mark Ramutis was riding out his symptoms at home when he awoke one morning unable to speak. At Allegheny General Hospital, a brain scan showed multiple clots and swelling in his brain. He died two days later.
“What we have is sort of a fragmented picture where there are some examples of very young people without risk factors having stroke,” said Dr. Ashis Tayal, a neurologist who directs stroke services at AHN. “There are other examples of older adults with risk factors, also having severe forms of COVID, so it's difficult to reconcile those easily at this point."
Chou and her co-authors are seeking to determine whether COVID-19 is a cause of stroke and other neurological symptoms, and if so, by what mechanism. She said it is unclear whether the novel coronavirus itself is causing the blood clots that are leading to strokes, or if the strokes are a secondary result of multiple organ failure among very sick patients.
The cases of the five Mt. Sinai patients complicate the latter theory, because their COVID-19 symptoms were not particularly severe. However, Chou cautioned that in areas such as New York City, where the virus has become endemic, it is possible that the fact that these patients had both strokes and COVID-19 could be coincidental.
“My gut feeling will be … they’re probably related, and that’s what everybody's gut feeling is saying,” Chou said. “But as medical professionals and scientists, a gut feeling is not good enough.”
More than 70 sites in 17 countries have registered through the Neurocritical Care Society website to collect patient data. It’s difficult to launch a new study during a pandemic, said Chou, and the contagiousness of the novel coronavirus makes it particularly challenging. That means, for now, they’re focusing on the most basic data that providers are already collecting at patients’ bedsides, including age, symptom severity, underlying conditions, the results of basic blood tests and general neurological function. In later phases of the study, Chou and her colleagues hope to collect data from more advanced diagnostic tests, such as MRIs.
It’s not clear how prevalent stroke and other neurological symptoms are in Covid-19 patients; that’s one of the primary questions driving Chou’s research.
“In order to know prevalence, we need to know … how many people out there [have been infected with COVID-19], and from that … we figure out what percentage or proportion of that population have this problem,” Chou said. “Because of the limited testing we still have … we don't really know how much COVID there is in the community.”
Chou expects the first results from the study to be available in late summer.