Be careful out there. Dr. Oxley has a statement in here that large strokes are treatable. Yes, if you just consider opening the artery treating then yes, But I don't stop there, I consider the lack of 100% recovery rehab protocols the worst failure in all of stroke. Notice the person mentioned at the top of the story is still hospitalized after one month. That shows a complete failure on the hospital's responsibility to have recovery protocols. And I bet they DID NOTHING to stop the 5 causes of the neuronal cascade of death in the first week, allowing billions of neurons to die. I lost 5.4 billion neurons that first week, it is the reason I did not fully recover. Until your stroke doctors acknowledge that they are completely failing their patients NOTHING WILL CHANGE.
Young and middle-aged people, barely sick with covid-19, are dying of strokes
Thomas
Oxley wasn’t even on call the day he received the page to come to Mount
Sinai Beth Israel Hospital in Manhattan. There weren’t enough doctors
to treat all the emergency stroke patients, and he was needed in the
operating room.
The
patient’s chart appeared unremarkable at first glance. He took no
medications and had no history of chronic conditions. He had been
feeling fine, hanging out at home during the lockdown like the rest of
the country, when suddenly, he had trouble talking and moving the right
side of his body. Imaging showed a large blockage on the left side of
his head.
Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.
The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.
As
Oxley, an interventional neurologist, began the procedure to remove the
clot, he observed something he had never seen before. On the monitors,
the brain typically shows up as a tangle of black squiggles — “like a
can of spaghetti,” he said — that provide a map of blood vessels. A clot
shows up as a blank spot. As he used a needlelike device to pull out
the clot, he saw new clots forming in real-time around it.
“This is crazy,” he remembers telling his boss.
Reports
of strokes in the young and middle-aged — not just at Mount Sinai, but
also in many other hospitals in communities hit hard by the novel
coronavirus — are the latest twist in our evolving understanding of the
disease it causes. The numbers of those affected are small but
nonetheless remarkable because they challenge how doctors understand the
virus. Even as it has infected nearly 2.8 million people worldwide and
killed about 195,000 as of Friday, its biological mechanisms continue to
elude top scientific minds. Once thought to be a pathogen that
primarily attacks the lungs, it has turned out to be a much more
formidable foe — impacting nearly every major organ system in the body.
Until recently, there was little hard data on strokes and covid-19.
There
was one report out of Wuhan, China, that showed that some hospitalized
patients had experienced strokes, with many being seriously ill and
elderly. But the linkage was considered more of “a clinical hunch by a
lot of really smart people,” said Sherry H-Y Chou, a University of
Pittsburgh Medical Center neurologist and critical care doctor.
Now
for the first time, three large U.S. medical centers are preparing to
publish data on the stroke phenomenon. There are only a few dozen cases
per location, but they provide new insights into what the virus does to
our bodies.
A
stroke, which is a sudden interruption of the blood supply, is a
complex problem with numerous causes and presentations. It can be caused
by heart problems, clogged arteries due to cholesterol, even substance
abuse. Mini-strokes often don’t cause permanent damage and can resolve
on their own within 24 hours. But bigger ones can be catastrophic.
The
analyses suggest coronavirus patients are mostly experiencing the
deadliest type of stroke. Known as large vessel occlusions, or LVOs,
they can obliterate large parts of the brain responsible for movement,
speech and decision-making in one blow because they are in the main
blood-supplying arteries.
Many researchers suspect strokes in covid-19 patients may be a direct consequence of blood problems that are producing clots all over some people’s bodies.
Clots
that form on vessel walls fly upward. One that started in the calves
might migrate to the lungs, causing a blockage called a pulmonary
embolism that arrests breathing — a known cause of death in covid-19
patients. Clots in or near the heart might lead to a heart attack,
another common cause of death. Anything above that would probably go to
the brain, leading to a stroke.
Robert
Stevens, a critical care doctor at Johns Hopkins Hospital in Baltimore,
called strokes “one of the most dramatic manifestations” of the
blood-clotting issues. “We’ve also taken care of patients in their 30s
with stroke and covid, and this was extremely surprising,” he said.
Many doctors expressed worry that as the New York City Fire Department was picking up four times as many people who died at home as normal during the peak of infection that some of the dead had suffered sudden strokes. The truth may never be known because few autopsies were conducted.
Chou
said one question is whether the clotting is because of a direct attack
on the blood vessels, or a “friendly-fire problem” caused by the
patient’s immune response.
“In
your body’s attempt to fight off the virus, does the immune response
end up hurting your brain?” she asked. Chou is hoping to answer such
questions through a review of strokes and other neurological
complications in thousands of covid-19 patients treated at 68 medical
centers in 17 countries.
Thomas
Jefferson University Hospitals, which operates 14 medical centers in
Philadelphia, and NYU Langone Health in New York City, found that 12 of
their patients treated for large blood blockages in their brains during a
three-week period had the virus. Forty percent were under 50, and they
had few or no risk factors. Their paper is under review by a medical
journal, said Pascal Jabbour, a neurosurgeon at Thomas Jefferson.
In
the vast majority of younger adults, covid-19 appears to result in mild
illness with the risk of more severe consequences rising with every
decade of age. According to Centers for Disease Control and Prevention
data, 0.8 percent of U.S. deaths as of Apr. 18 were in people ages 25 to
34; 2 percent among those 35 to 44; and 5.4 percent among those 45 to
54.
Jabbour
and his co-author Eytan Raz, an assistant professor of neuroradiology
at NYU Langone, said that strokes in covid-19 patients challenge
conventional thinking. “We are used to thinking of 60 as a young patient
when it comes to large vessel occlusions,” Raz said of the deadliest
strokes. “We have never seen so many in their 50s, 40s and late 30s.”
Raz
wondered whether they are seeing more young patients because they are
more resistant than the elderly to the respiratory distress caused by
covid-19: “So they survive the lung side, and in time develop other
issues.”
Jabbour
said many cases he has treated have unusual characteristics. Brain
clots usually appear in the arteries, which carry blood away from the
heart. But in covid-19 patients, he is also seeing them in the veins,
which carry blood in the opposite direction and are trickier to treat.
Some patients are also developing more than one large clot in their
heads, which is highly unusual.
“We’ll
be treating a blood vessel and it will go fine, but then the patient
will have a major stroke” because of a clot in another part of the
brain, he said.
The 33-year-old
At
Mount Sinai, the largest medical system in New York City,
physician-researcher J Mocco said the number of patients coming in with
large blood blockages in their brains doubled during the three weeks of
the covid-19 surge to more than 32, even as the number of other
emergencies fell. More than half of were covid-19 positive.
It isn’t just the number of patients that was unusual. The first wave of the pandemic has hit the elderly and those with heart disease, diabetes, obesity or other preexisting conditions disproportionately. The covid-19 patients treated for stroke at Mount Sinai were younger and mostly without risk factors.
On average, the covid-19 stroke patients were 15 years younger than stroke patients without the virus.
“These are people among the least likely statistically to have a stroke,” Mocco said.
Mocco,
who has spent his career studying strokes and how to treat them, said
he was “completely shocked” by the analysis. He noted the link between
covid-19 and stroke “is one of the clearest and most profound
correlations I’ve come across.”
“This is much too powerful of a signal to be chance or happenstance,” he said.
In
a letter to be published in the New England Journal of Medicine next
week, the Mount Sinai team details five case studies of young patients
who had strokes at home from March 23 to April 7. They make for
difficult reading: The victims’ ages are 33, 37, 39, 44 and 49, and they
were all home when they began to experience sudden symptoms, including
slurred speech, confusion, drooping on one side of the face and a dead
feeling in one arm.
One
died, two are still hospitalized, one was released to rehabilitation,
and one was released home to the care of his brother. Only one of the
five, a 33-year-old woman, is able to speak.
Oxley,
the interventional neurologist, said one striking aspect of the cases
is how long many waited before seeking emergency care.
The
33-year-old woman was previously healthy but had a cough and headache
for about a week. Over the course of 28 hours, she noticed her speech
was slurred and that she was going numb and weak on her left side but,
the researchers wrote, “delayed seeking emergency care due to fear of
the covid-19 outbreak.”
It turned out she was already infected.
By
the time she arrived at the hospital, a CT scan showed she had two
clots in her brain and patchy “ground glass” in her lungs — the opacity
in CT scans that is a hallmark of covid-19 infection. She was given two
different types of therapy to try to break up the clots and by Day 10,
she was well enough to be discharged.
Oxley
said the most important thing for people to understand is that large
strokes are very treatable. Doctors are often able to reopen blocked
blood vessels through techniques such as pulling out clots or inserting
stents. But it has to be done quickly, ideally within six hours, but no
longer than 24 hours: “The message we are trying to get out is if you
have symptoms of stroke, you need to call the ambulance urgently. ”
As
for the 44-year-old man Oxley was treating, doctors were able to remove
the large clot that day in late March, but the patient is still
struggling. As of this week, a little over a month after he arrived in
the emergency room, he is still hospitalized.
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