As many as 62 people diagnosed with COVID-19 suffered a stroke in the city during the infection between June and August. Of these 16% died in hospital, a study by doctors from St John’s Medical College Hospital has revealed.
The multi-centre retrospective study from 13 hospitals has been accepted for publication in the International Journal of Stroke, the official publication of the World Stroke Organization.
A stroke is the sudden onset of neurological deficit due to vascular causes.
Thomas Mathew, Professor and Head of the department of Neurology at St. John’s Medical College Hospital, who is the principal investigator of the study, told The Hindu that COVID-19 related strokes (CORS) are associated with increased mortality and morbidity.
“We found that mortality among the 62 CORS was high compared to the non-COVID-19 strokes diagnosed during the corresponding period last year. While 111 suffered a stroke from June to August last year according to St. John’s Stroke Registry, no death was reported,” he said.
Of the 62 CORS, 60 (97%) patients had ischemic strokes while two (3%) had haemorrhagic strokes. A majority of them (59.7%) had a “bad” stroke wherein the large artery was blocked.
The mean age of patients was 55.66 with a standard deviation of 13.20 years. While 34 (77.4%) were male patients, 26 % (16/62) of patients did not have any conventional risk factors for stroke.
Risk factors
Attributing CORS in those without risk factors to inflammation triggered thrombosis and damage to endothelium due to COVID-19, Dr. Mathew said: “However, in the remaining 46 patients, 54.8% had diabetes, 61.3% had hypertension, 8% had coronary artery disease, and 4.8% had atrial fibrillation.”
Manifestations
City-based neurologists said they were seeing various neurological manifestations of COVID-19.
Amit Kulkarni, consultant neurologist at SPASRH Hospital, said with COVID-19 the problem was not just the sequelae of lung involvement but also varied other aspects like clotting occurring in the arteries of the lung, arteries of the brain, veins in the leg and venous sinuses in the brain, causing deep vein thrombosis, pulmonary embolism, arterial and venous strokes in the brain.
“What is also unusual about this disease is the varied immunological manifestations like limp paralysis of arms and legs (Guillian Barre syndrome), facial paralysis with asymmetry, cranial nerve palsies causing double vision, drooping of the eye and muscle involvement (myositis). We have noted quite a few peripheral nerve palsies presenting with foot drop in patients recently affected or recovering from COVID (inability to extend the foot) where the other routine blood work is negative for any connective tissue disease and there is no spinal/peripheral cause of nerve compression,” he said.
G.T. Subhas, former president of Bangalore Stroke Support Group and former director of Bangalore Medical College and Research Institute said the common symptoms of stroke can be remembered by Facial Drooping, Arm Weakness, Speech Difficulties and Time to reach a stroke ready hospital abbreviated as FAST.
Do not ignore
“Both during and post COVID-19, people should not ignore warning signs such as dizziness, sudden weakness in limbs and difficulty in speaking or understanding words. “Patients should reach the hospital within three or four hours of the stroke. The earlier the patient is rushed to a hospital, the better the outcome,” he added.
Hospitals that were part of the study included St. John’s, Bengaluru Medical College and Research Institute, Manipal Hospitals, Sakra, Apollo, M.S. Ramaiah, Satya Sai Institute of Higher Medical Sciences, and Narayana Health.
