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Hemorrhagic stroke among COVID patients

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Dr Vipul Gupta
While the COVID pandemic has turned the world upside down, posing a threat of multitude of problems, many people have also lost their lives. Though people know that the virus affects the pulmonary system and also witnessed many cases of depleted SP oxygen levels (Saturation pressure) in COVID infected patients throughout India, yet a lesser-known fact is that the infection also involves the brain and the nervous system in many of the patients.
In COVID-19 patients, the interaction of the virus with the receptors in the cerebral blood vessels has been attributed to stroke, which has been studied globally. Recent studies are evident enough to reveal that around 30 – 40 % of the patients may develop some brain symptoms, more so with either severe COVID symptoms or pre-existing/underlying problems.
A majority of the COVID positive patients with brain problems have been found to have stroke, while some have conscious problems. Although the incidences of reported cases of ischemic stroke were relatively low (upto 5-6% of all COVID patients), the mortality associated with the hemorrhagic stroke in patients with COVID infection has been as high as 38%.
Some patients also had complaints of muscle injury, which is regarded as a part of nervous system In fact, loss of sense of smell among the COVID patient has also been reported which is also a feature or involvement of he nerves that detect our sense of smell
Intracerebral Hemorrhage amid COVID patients
Many studies have been conducted in order to find out the root cause of the problem. One of the reason thought is that there is increased level of certain chemicals (protein fragments in the body called as D-Dimer) that is responsible for increasing the clotting tendency of the blood.
Various studies conducted have been conclusive that both ischemic and haemorrhagic stroke are associated with COVID-19 infection and carry a high risk of mortality. Pertaining to the ACE2 receptors, circulating cytokines, and hypercoagulability being integral in the pathogenesis of stroke in COVID-19 patients.
Globally, doctors have reported cases of stroke in COVID positive patients including from countries like England, US and China. However, the stroke in these patients are very different from what is seen in other patients without COVID infection Strokes are happening in a younger age group, in the age bracket of 50 to 55 years, while normally it occurs in much older age (above 65 to 70 years).
Apart from COVID infection, the patients having stroke are without any underlying problems. Usually, stroke is common in the geriatric population who have pre-existing co-morbidities like hypertension, diabetes or cholesterol, or chain smokers. But COVID is affecting the younger population with no such risk factors and still they are getting a stroke attack.
While the symptoms of stoke may be first symptoms in some, before even being diagnosed with COVID, and in some cases the patients may develop stroke within 7-10 days of COVID diagnosis.
Missing the golden period of diagnosis
Since the inception of lockdown, there has been a decline in the number of emergency cases. The patients of stroke reaching the hospital within the golden period has highly reduced in numbers. This phenomenon has been seen world over.
Many elderly living alone, due to social distancing and isolation, the acute stroke in them has gone unnoticed. Furthermore, now a days, even in a family if someone develops a stroke, the family is afraid to take the patient to the hospital as they are worried about themselves or the patient catching COVID infection. Sadly, if the patient does not come to us in the golden period of first 6 to 8 hours of stroke, then the treatment does not do not have very good outcomes.
Timely treatment is the solution
Doctors are also facing challenges in treating these patients in emergency. Some of them may have COVID; however doctors can’t wait for the virus diagnosis before undertaking emergency treatment.
Dr Vipul Gupta explained that his team is are doing immediate CT scan of chest to look for virus infection. Our anesthesia team has also developed a technique avoids virus spread. We are also taking precautions such as using “respirators” along with screens instead of simple masks during neurointervention procedures. This has helped us to treat these patients in emergency without waiting for virus tests.
At Agrim Institute, which is one of the renowned and one of the largest stroke team in the private sector in this region has established a protocol that still we are able to treat these people in time. Our team has been a part of the renowned doctors who written guidelines which has been published in international journals about how to treat the stroke in patients with COVID symptoms.
(The author is Director, Neurointervention, Agrim institute for neuro sciences, Artemis Hospital)

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