Stroke of luck

Covid-19 has shown to manifest itself in multiple ways as sometimes neurological symptoms are seeming to occur before respiratory distress or fever, warns Dr Vikram Huded

Stroke is a major cause of death and disability in India. The ongoing pandemic has intensified this problem as Covid-19 has shown to manifest itself in multiple ways because sometimes, neurological symptoms are seeming to occur before respiratory distress or fever. More than one-third of the patients may present with neurological symptoms — associated with the central nervous system (CNS) — including stroke. Such neurological symptoms are more common in patients with a severe infection and among people with a history of hypertension, cardiovascular disease, diabetes and lifestyle habits like smoking.

Causes of a stroke

An initial analysis from April 2020 projected that an estimated 5% of patients detected with Covid-19 present with stroke during hospitalisation. However, another analysis conducted by the same group of investigators stated that stroke is infrequently associated with Covid-19, but usually occurs in the presence of other cardiovascular risk factors, such as diabetes, hypertension, etc. Nevertheless, there are three known health challenges of stroke and Covid-19:

♦ Increased clotting of blood as a result of Covid-19 related widespread inflammation.

♦Inflammation of blood vessels due to the immune response

♦ Heart-related diseases due to respiratory failure/low oxygen saturation, along with widespread inflammation.

Although there are still some contrasting views on the association of Covid-19 and stroke, Covid-19 patients with associated comorbidities are at an increased risk of stroke. This makes it imperative to reach a stroke-ready hospital in time for a patient exhibiting stroke-like symptoms.

Be quick to identify stroke symptoms. If you experience any of these symptoms or notice them in your near ones, rush them to the nearest emergency centre:

♦ Balance issues

♦ Eyesight challenges, such as blurry vision

♦ Facial drooping on one side

♦ Arm weakness

♦ Speech difficulties, such as slurred words

Be sure to mention if your patient is Covid-19 positive or a Covid-19 suspect and the emergency centre will triage the patient as per their protocol to the proper ward to start treatment and minimise virus exposure.

Being stroke-aware

While you may be under physical isolation because of Covid-19 infection, this may pose a hurdle to spot symptoms. Fortunately, communication technology provides an opportunity to actively take few measures to identify these symptoms remotely.
Many elderly patients are now tech-savvy and use video chat — this can be used to observe slurred speech or deficient conversational skills.

Look out for these signs: are they disoriented or confused? Watch their movements as well. Are their eyes tracking properly? Can they smile? Can they lift both their arms away from their body? If they can’t, they may be experiencing stroke symptoms.

The moment you suspect that the patient is having a stroke or had one recently, even in the current Covid-related clinical scenario, quickly shift them to the nearest stroke-ready hospital. Remember the consequences of waiting — potential disability, decreased quality of life, or death — vastly outweigh the minimal risk of Covid-19 exposure at the hospital.

Though the pandemic might seem overwhelming at times, we can still control many aspects of patient care if initiated at the right time.

For concerns like Covid-suspects, consult your doctor for the appropriate approach. Ask your doctors about virtual visits, telemedicine or tele-stroke programmes, as applicable. Moreover, strive to stay active and healthy.

Work towards maintaining a healthy lifestyle to keep multiple comorbidities like diabetes, hypertension, etc., under control. Continue with your regular medication, in consultation with your doctor. Covid-19 has indeed greatly impacted the world, especially the world of medicine.

However, stroke symptoms should still be considered as a medical emergency, and the fear of the virus should not impede our ability to provide stroke patients with fast, timely, and effective emergency care.

(The author is a senior consultant
interventional neurologist.)