The woman, 33 years old, had complained for a week about cough, headache, and chills. Finally, her condition deteriorated rapidly: she got difficulty Speaking and left side of his body felt numb and weak. Out of fear of infection with Sars-CoV-2, the wife took the first place, no medical aid. A serious miscalculation, as it turns out, should be: in fact, they hovered in mortal danger. She had suffered a stroke and was long suffering from Covid-19 – as well as four other younger patients, a New York-based doctors reported to the team this week in the journal “The New England Journal of Medicine” (NEJM).
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Strokes are not always, but often a disease of old age. The average age of those Affected is relatively high and is located in Germany about 75 years for women and 68 years for men. The New York patients, the Team writes to Thomas Oxlay from the Mount Sinai hospital, by contrast, are between 33 and 49 years old. They were all ill only slightly Covid-19, showed no or hardly any symptoms.
Before the stroke, most of them were in good health: Two patients, including the woman, had no pre-existing conditions. A middle-aged man had high blood pressure, another Diabetes, if not diagnosed. The oldest of them, a 49-year-old man, who suffered from Diabetes and had suffered in the past, had a mild stroke. To re-clots, he took Aspirin and a cholesterol-lowering drug.
Usually, the physicians treat in the course of two weeks, on average less than a stroke patient is younger than 50 years, write in the “NEJM”. Now it was in the course of two weeks, five – a noticeable increase, albeit at a low level. Could be the infection with the Coronavirus a role?
According to Professor Peter Berlit, the messages from New York are not isolated cases. “There are similar case reports from China and Italy,” said the neurologist and the General Secretary of the German society for neurology (DGN). In Germany no comparable cases in young Covid patients are not yet known.
A recently published study from Wuhan, points in a similar direction: Five out of 88 patients with severe forms of the disease had suffered a stroke; 40 of them showed neurological symptoms. Whether these, however, were a direct result of infection – or, rather, an expression of severe concomitant diseases, which may lead to serious Covid-19-gradients – is currently unclear.
Certain infections increase stroke risk
The phenomenon that infections with certain pathogens can increase the risk of stroke is not new. It is also observed in other viral or bacterial diseases: there were, also, in the first Sars Virus has a connection with strokes. It was known also, that, among other things, the tuberculosis and the Syphilis pathogen, and the varicella-Zoster Virus (causative agent of chicken pox) can lead to a stroke, so Berlit. “This is attributable to an inflammation of the vessel wall, a so-called vasculitis,” says the neurologist.
On the basis of the previous publications, the risk could be increased also in the case of Covid-19, Berlit. A Problem of the previous Covid-19-case series, however, is that the data have already been collected prior to the start of the study, in so-called retrospective studies. The results should be confirmed in specially designed, so-called prospective studies. Add to: Based on the total number of infections, are the messages so far are very low.
It is unclear yet what the likely increased risk is due. As possible causes are currently being discussed, an increased tendency to Thrombosis or injury of the endothelium, so Berlit, either by the Virus itself, or an inflammatory response.
The endothelium is the cell layer that lines, among other things, blood vessels. She was at Covid-19-patients “massively involved”, said Stefan Schreiber, Professor of Internal medicine, University hospital of Kiel in a recent Interview with the star. “Covid-19 was at the beginning as a pure pulmonary disease. Today, however, we know that the lung is probably the main symptom carriers of the infection and it is rather a systemic disease,” said the doctor. Also, there is evidence that the Covid-19 will have no impact on blood clotting as well as heart and liver.
Most of the strokes go on the account of blood clots
In Germany, every year there are around 270,000 strokes. The most common cause of a stroke is a Vascular occlusion, which leads to a circulatory disturbance in the brain is called a cerebral infarction. Such were the New York patients ill. Bleeding in the brain due to a ruptured vessel be seizures also counted the blow. You are for about 15 percent of all strokes. Risk factors include, among other things, high blood pressure, Diabetes, Smoking, malnutrition, lack of exercise and heart disease, especially atrial fibrillation.
Strokes are treated, in principle, well – in the fight against blood clots, however, time is an important factor. “Vessel closures must be opened within a maximum of six hours,” says Peter Berlit. This can be either with medication is possible, or mechanical process. “Then it goes to the Stroke Unit in order to Prevent complications and early Rehabilitation.”
A Problem in the current Corona pandemic, however, is that stroke can patients a lot of time, before they call the ambulance. “Out of fear of contagion, Affected to call with minor strokes or transient warning symptoms not the 112 or go to the urgent care, or practice,” warns the neurologist.
If there are symptoms, immediately 112 call
A Problem that the New York Doctors report: “Two patients in our case series, have not immediately called for an ambulance, because they were afraid to go during the pandemic in a hospital.” Whether this has affected the result negatively, don’t write the doctors. Nevertheless, there is an important message: “We are trying to convey to the people out there: If you have symptoms of a stroke, you must call immediately the ambulance,” said Oxley in an interview with the “Washington Post”. (A detailed Symptom description can be found here.)
As it is with the five young stroke patients now, there are a few information. According to the “Washington Post” died in one of the patients, two more were still in the hospital, another had been discharged to rehab, and fifth in home care.
Only one Patient – the 33-year-old woman – is currently able to speak.
Source: “The New England Journal of Medicine” / “Washington Post”
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