An alarming surge in strokes among young and middle-aged people with mild symptoms of COVID-19 is baffling doctors, who are scrambling to understand the phenomenon as they try to save lives, according to a report published by the Washington Post on Saturday.
The Post highlights a scene as it unfolded at Mount Sinai Beth Israel Hospital in Manhattan:
Dr. Thomas Oxley, an interventional neurologist, wasn’t even on call the day he received the page to come to the hospital. 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 saying.
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. Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon.
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.