We are wrapping up May Stroke Awareness Month. At NINDS, stroke is in our name and we are strongly committed to funding research in stroke, from basic to translational to clinical studies. The clinical work we support includes research to prevent stroke, to treat acute stroke in an emergency setting, and to improve the brain’s ability to recover from stroke.
We can receive the greatest public health benefit if lifestyle change and medications can prevent a stroke from ever occurring. Indeed, the great success story started 50 years ago, and stroke risk has dropped each year until recently. However, last year stroke risk increased for the first time. It’s a warning bell that we need to redouble our efforts to control high blood pressure, high cholesterol, and obesity and we must promote exercise and a healthy diet. In fact, we believe these measures will not only prevent stroke and heart attack but also decrease cognitive decline and dementia that comes as we age. Our message is: Mind Your Risks!
The most dramatic advances have occurred in acute stroke treatments. Today’s ability to return blood flow to the brain in ischemic stroke patients means that the best chance for surviving a stroke and escaping life-long disability is seeking medical attention as soon as possible after symptoms appear. Dialing 9-1-1 and getting to the emergency room within minutes to hours of symptom onset allows clot-busting drugs to be given and provides the best opportunity for recovery. Because brain cells are dying continuously, the earlier someone gets treated, the better.
The links between stroke recovery and other diseases and disorders continue to be investigated, particularly as our country continues to grapple with the coronavirus pandemic. What was initially considered a respiratory infection can make its way into other organs, including the brain. Recent reports indicate that the virus may causes blood clots to form in small blood vessels in the brain as well as in the heart, lungs and other organs. A preliminary observational study by researchers from Mount Sinai hospital in New York City suggests that patients with COVID-19 who required mechanical ventilation and got blood thinners did better than those who did not get blood thinners, but the risk vs. benefit of strong blood thinners in the greater COVID-19 population requires careful study. And in children, a condition called “multisystem inflammatory syndrome” is linked to COVID-19 infection and causes stroke and inflammation of the heart and other organs. Researchers suspect that the lining of blood vessels can be infected by SARS-CoV-2, but direct evidence is lacking.
Even more alarming, blood clots caused by coronavirus may lead to major strokes in young people. The New England Journal of Medicine recently published a case series that described five COVID-19 patients, ranging in age from 33-49, who experienced large-vessel strokes. Two of the patients delayed seeking treatment because they were scared to go to the hospital during the pandemic. This is emblematic of a dramatic decrease across the country in the number of strokes and heart attacks being treated during the pandemic. There is no evidence yet for a decrease in these events, but instead there is concern about people’s reluctance to call 9-1-1 and go to the hospital as the pandemic rages on. Stroke, whether coronavirus-related or not, is a medical emergency that requires immediate attention. If someone is experiencing a stroke, it is critical that they call 9-1-1 and get to the emergency department as soon as possible.
A thorough understanding of this virus will require learning about its connections to neurological diseases beyond stroke. While stroke is has been connected with coronavirus,, other neurological diseases have as well (see a recent editorial by NINDS Clinical Director, Dr. Avi Nath). For instance, a loss of smell (anosmia) and taste (ageusia) have been reported in COVID-19 patients, and some also describe muscle pain that is more severe than the aches usually associated with viruses. Moreover, neurological problems have been reported toward the end of the COVID-19 viral course. One case of acute necrotizing hemorrhagic encephalopathy is described in Radiology. Cases of Guillain Barre Syndrome associated with COVID-19 have also been reported. A recent report of five patients in Italy revealed that Guillian Barre occurred 5-10 days after the onset of coronavirus.
Medical reports continue to come in from around the world, and clinicians and researchers are working tirelessly to understand the effects and impact of the novel coronavirus on the human body. At NINDS, we recognize the urgent need for more research on this new virus, and particularly on ways it affects the nervous system. NINDS recently issued a Notices of Special Interest encouraging researchers with existing grants to apply for supplements to study the effects of COVID-19 on the nervous system and to establish a database that will collect clinical information on neurological symptoms experienced by those suffering from SARS-CoV-2. It is absolutely critical to gather and analyze information about COVID-19 related neurological problems from patients of all ages and ranges of disease severity.