April 27, 2020
There is a new emerging data set that describes a rare but serious consequence to COVID19 disease, stroke or brain blood vessel clot obstruction. This is a frustratingly bad wrinkle in the continually changing landscape that is COVID. The ages are ranging from as young as 30 to 80 years old. This is a dramatic departure from what we consider a "normal" age predilection for strokes in general.
What is happening in these exceedingly rare but tragically affected individuals? No one knows yet.
There are some early signs that it is the immune system overreacting as it is doing throughout the body. There are some findings of proteins called anti-phospholipid antibodies that may be an autoimmune reaction triggered by the virus that are mediating an attack on the blood vessels. The antibody attacks the phospholipid portion of cell membranes causing inflammation. Subsequently, blood clots or thromboses can form blocking blood flow to the tissue that is downstream of the blockage. If this occurs in the brain, it is called a stroke.
The SARS2 virus apparently has found a way in a very rare and select group to cause these clots to form before the virus ravages the lungs and causes death. Patients are showing up in emergency rooms with neurological symptoms indicative of a stroke including extremity weakness, inability to speak, dizziness, visual deficits and more.
The reason that I am writing about this rare complication is that individuals experiencing these symptoms are not seeking help rapidly because of COVID fears. This is a tragic choice as rapid intervention with specialized anticoagulant medicines can be life saving and brain pathology sparing. The risk of avoiding care for fear of coronavirus is not a good tradeoff as COVID is 99% likely to not harm you where your acute problem can.
The take home point of this short discussion is simple: if you are experiencing any serious symptoms as stated above or heart attack symptoms that are not specifically related to the virus but maybe, you need to seek medical care immediately to reduce your chances of a negative outcome.
A rapid intervention is critical,
Dr. M
NEJM Correspondance Coagulopathy Article
NEJM Correspondance Neurologic Article
Cha Washington Post Article
