Ischemic Strokes in Young People with COVID-19

June 23, 2020 by Sam Bazzi

Another week, another study on horrifying brain injuries associated with COVID-19… Let’s get started. Although I’ve mentioned reports of stroke in previous reviews of neurological symptoms in COVID, I have not yet covered the published case reports describing ischemia.

A case study came out in the New England Journal of Medicine that described cases of large-vessel stroke in young patients (<50 years old), with one of the patients being a 33 year-old woman with no previous health problems (Oxley et al., 2020). Five patients described in this study tested positive for SARS-CoV-2 and their mean National Institutes of Health Stroke Scale (NIHSS) scores were 17, consistent with ischemic stroke with large artery involvement. All five patients were treated at Mount Sinai in New York during a single two-week period. This is notable because the authors also mention that over the previous year, their service only saw an average of 0.73 patients presenting with large-vessel stroke every 2 weeks, so these COVID-19 positive cases represent a big spike in ischemia among people under 50 years old. Coagulopathy and vascular endothelial dysfunction were mentioned as potential causes, but no definitive mechanism has been identified. 

So far, there have not been any studies that have identified the particular strain of virus present in the US. Because the European strain has been associated with higher prevalence of ageusia and anosmia, it has been hypothesized that the European strain may lead to higher neurological symptoms compared to the Wuhan strain (see blog post from 6/8/20). Epidemiological studies need to be conducted in order to identify the prevalence of COVID-19-related neurological symptoms across the US, as well as identify which strain of SARS-CoV-2 exists in different regions. Correlating these two pieces of information may offer a clue as to how mutations in the spike protein correlate with neurological symptom presentation in COVID-19. Further, it would be interesting to identify any common genetic or environmental risk factors amongst these young patients that present with stroke.

Written by: Sam Bazzi
Edited by: Jina Zhou and Esther Melamed
6/23/2020