COVID-19: strokes and other neurological effects
27th July 2020
One damaging but often overlooked consequence of the global pandemic is that the fear of catching COVID-19 has prevented a considerable number of people from seeking medical help when they need it most.
At the same time, as the pandemic progresses we are learning more about the neurological impact of the virus, i.e. the effects it can have on the brain. Dr Joseph Kwan is the Clinical Lead at St John and St Elizabeth Hospital’s Stroke Unit, and he spoke to us about how COVID-19 has been affecting stroke patients, and how treatment has been adapting in light of new information about the virus.
At the peak of COVID-19, admissions for stroke patients dropped by a quarter
This isn’t because fewer people were having strokes but because patients have been scared of leaving their homes and coming to hospital. It’s better now, but it has been a very strange time; even after having a stroke, a significant number of patients have not called an ambulance or come to the hospital.
Essentially, there are three groups of people who have had strokes but have not been treated at a hospital stroke unit. There are those who’ve had mild strokes; their arm has gone numb, their face is a bit droopy, or they are limping from a little bit of leg weakness. They know they are having a stroke, but they are so scared of catching COVID-19 in hospital that they choose to stay at home and not call an ambulance.
Then there are the people who have had severe strokes but are living with someone, so their spouse or children are able to call 999, but even when they arrive at hospital, a significant number of these patients refuse to be admitted and insist on going home.
Finally, there are those who live alone and have had very severe strokes, who might have collapsed onto the floor, be unable to talk or reach a phone to call for help. During lockdown, there has been a decrease in people visiting their friends and family, so some of those living alone will have had strokes and died without anyone realising what has happened.
Anyone who has had symptoms of a stroke needs to get checked out as soon as possible
First of all, they need to go and see the specialist, get checked out and have all the necessary investigations: brain scan, heart scan and blood test. Secondly, if they are experiencing any consequences of the stroke – such as weakness in the limbs or speech problems – they should see a therapist in order to get rehabilitation. The stroke service offered through St John and St Elizabeth Hospital can help them recover and regain their function and independence.
Likewise, anyone who has had COVID-19 should see a specialist as soon as possible as well, to see if there have been any complications from the virus. These complications could be very subtle – whether that be in your brain, your lungs or your blood. For example, a brain scan could reveal that you’ve actually had a silent stroke during that time.
COVID-19 itself is a risk factor for a stroke
A lot of studies have found that when you have COVID-19 your blood is thicker, meaning it is more likely to clot. People are more likely to get clots in their lungs or in their brain, and when you have a clot in the brain it gives you a stroke.
What we’ve also been seeing is that when patients go on to blood thinners they’re more likely to bleed which can lead to further complications after the stroke such as a brain haemorrhage.
Overall, we’re finding that probably around one in 20 patients with COVID-19 may experience a stroke, especially those who have severe COVID-19 infections.
We are learning about other neurological symptoms of COVID-19 as well
One symptom that is becoming more widely recognised is a loss of sense of taste and smell.
This is an indication that the virus has made its way into your brain. That is the reason that your taste and smell have gone – because the virus has gone through your nose, through the base of your skull and into your brain.
Other neurological symptoms might include numbness and weakness in the arms and legs, and some people get severe headaches. Some even have problems with their memory, and their mental processing is slower because the virus has attacked the brain which means they are not quite as sharp as they were before.
We’re currently redesigning the COVID-19 follow-up pathway
There is a national programme to assess every single COVID-19 patient in order to investigate the consequences and effects of the virus on these people in the long term. One of the research projects that I’m leading at Imperial College Healthcare NHS Trust will be testing the memory and cognitive function of people who have had COVID-19.
At Imperial, every single person who has tested positive with COVID-19 will be followed up in the clinic. If any of them have experienced stroke symptoms, then they will be referred to our stroke service.
The best thing to avoid COVID-19 is to stay as fit as possible
We should be encouraging everyone to minimise their risk of being infected with COVID-19 by staying as fit and healthy as possible. Apart from social distancing, wearing face masks and handwashing, we should work towards boosting our own immunity; that is something we should all do straight away, rather than waiting until it affects you. As well as staying generally healthy and active, you should get enough vitamin C, vitamin D and zinc from your diet and, if necessary, from supplements.
If you believe you or a loved one has had a stroke or have displayed any stroke-like symptoms call our Stroke Unit and we can arrange for you to have a consultation with one of our stroke specialists.