Understanding Stroke Risks in Young Adults

Recent research published in the New England Journal of Medicine highlights a concerning trend: young adults with COVID-19 may face a heightened risk of stroke. The study details five cases from New York, where patients under the age of 50 experienced large artery strokes, specifically large vessel occlusion strokes (LVO). These strokes occur when blood flow is obstructed in major arteries supplying the brain, leading to potential brain tissue damage or death.

Strokes, also known as cerebrovascular accidents (CVA), can manifest in various forms, and their clinical presentation varies based on type and location. Typically, strokes are more common among older individuals or those with health issues. In assessing stroke patients, factors such as age, obesity, diabetes, smoking history, heart disease, cancer history, prior strokes, and family history are crucial.

However, the alarming cases discussed in the NEJM involved individuals under 50, including a 33-year-old with no prior health conditions. This revelation raises questions about the safety of returning young, healthy individuals to the workforce amidst the pandemic. Although the findings are concerning, it remains uncertain whether they will shift the ongoing discussions.

The outcomes from this case series indicate that three out of the five patients were discharged either to their homes or rehabilitation centers, showing some recovery in their NIH stroke scores. Among the patients, four were male, and three had known conditions such as diabetes and hypertension that could exacerbate COVID-19 complications. The most critically ill patient was a 39-year-old with untreated hypertension, suggesting that his need for mechanical ventilation may have been linked more to pneumonia than to a stroke. The authors did not provide details on other potential risk factors that could have contributed to these strokes.

Despite the gravity of these individual cases, the overall data from this study is limited due to the small sample size. Thus, it is premature to conclude that young COVID-19 patients will commonly experience strokes. For context, a recent preprint study from Wuhan noted that only about 5% of 221 hospitalized COVID-19 patients had large vessel strokes, predominantly affecting older individuals, with very few under 50. This finding aligns with previous reports noting a low incidence of LVO strokes in other viral infections.

The first video titled "Stroke Is Increasing in Younger Adults and Yes, It's Scary" discusses the rising incidence of strokes among younger populations, emphasizing the need for awareness and preventive measures.

Further insights into heart issues associated with COVID-19 were also published in the NEJM, focusing on ST-elevation myocardial infarctions (severe heart attacks). Notably, many patients in this cohort had non-obstructive coronary disease, suggesting unexpected heart complications. However, all patients were over 50, which raises questions about whether similar trends might emerge among younger patients if stroke rates continue to rise.

Given the known connection between COVID-19 and increased blood clotting, any potential correlation between strokes and heart attacks in younger patients remains speculative. Without clear evidence of a unique predisposition among the five younger patients, these cases may simply represent unfortunate anomalies.

As always, reports like those in the NEJM can help identify specific risk groups, but further data is necessary for conclusive clinical or policy recommendations. It is crucial to stress that anyone experiencing stroke symptoms should seek medical attention immediately. Several patients in this small cohort delayed seeking help, with one waiting as long as 28 hours despite clear signs of a severe stroke.