Coronavirus Could Cause Strokes in Young Adults

30 May, 2020
Recent reports from New York City raise suspicions about the possibility that coronavirus could cause strokes, especially in young people. Cases have already been reported, and there are several hypotheses.

The COVID-19 pandemic began in Wuhan, China, in late 2019 and is now ravaging the world. New data regarding the disease is constantly emerging. Health teams are becoming more alert to the symptoms and seem to be discovering new side effects of the virus. This includes the possibility that coronavirus could cause strokes in young adults.

In a story reported in The Washington Post, doctors in the United States report an increase in strokes. Worryingly, this is occurring especially in young people infected with coronaviruses.

This adds to reports from China, where Wuhan neurologists have found that up to 36% of patients hospitalized with SARS-CoV-2 had some neurological symptoms. This denotes some disease involvement linked to the brain and neurons.

Theories about the increase in strokes in patients with coronavirus focus on three possible mechanisms:

  • The neurotropism of the virus, which can infect neurons and, in that framework, produce changes in the central nervous system. This then leads to neurological symptoms, putting the brain at risk.
  • Coagulopathies derived from infection by platelet and coagulation factor failures.
  • A cytokine storm, which is a rare condition that consists of an abrupt reaction by the immune system, in its fight against the infection. The side effects include changes in coagulation.

Does the coronavirus infect the brain?

We know that the coronavirus primarily targets cells in the pulmonary alveoli. It enters them through the ACE2 protein, which functions as a receptor for their surface spicules.

However, we also have these receptors in other cells. Because of that, researchers suspect that SARS-CoV-2 may enter other tissues, just as it does through the pulmonary pathway. As far as neurons are concerned, the viral entry is not fully scientifically proven by trials. However, patients’ symptoms are pointing in that direction.

The presence of strokes in young people with coronavirus could be included in the list of symptoms and neurological disorders recorded among patients. We should, of course, include anosmia. There is little doubt that this is an initial neurological sign in asymptomatic people.

A woman smelling.
Loss of smell is considered a neurological symptom of coronavirus, which would confirm its neurotropism

Read more: Is a Loss of Smell a Possible Coronavirus Symptom?

Coronavirus could cause strokes: Clotting failures

Reports from less than a week ago show that there are cases where patients with COVID-19 have failures in their blood coagulation system. These failures involve coagulopathies and the detection of antiphospholipid antibodies.

When a person has these failures, whatever their underlying disease, there’s a high risk of one of their vital organs being infected. This could cause a heart attack or a stroke, for example.

The possibility of patients with coronaviruses having a stroke, even if they’re young, impossible. Despite having a robust immune system, an adult in their 30’s and 40’s can do little to stop clotting from occurring in the blood system.

Remember that there are two types of strokes: ischemic and hemorrhagic. In the first type, blood vessels become blocked with clots. As a result, the irrigation in one area of the brain is interrupted. In the latter, a blood vessel bursts, with similar results to the first type.

Cytokine storms

Coronavirus could cause strokes.

Three hypotheses may explain coronavirus strokes: neurotropism, clotting failures, and cytokine storms. “Cytokine storm” is a term used in the medical world to refer to a common process among patients with sepsis. These are people who have a widespread infection in their bodies. This is coupled with an uncontrolled immune system response.

Cytokines are substances used by the human immune system to communicate. Overall, defense cells do one of two things. They either create these cytokines to send a message to other cells further away, or they activate proteins and receptors. If this means of communication produces too many messages of this type due to a particularly potent infection, then it leads to a huge inflammatory activation.

A cytokine storm is severe, and difficult to control with medication. It’s closely linked to the COVID-19 fatalities, and much of the research to find drugs points to cytokine inhibitors.

In a cytokine storm scenario, neurological involvement and strokes are possible due to coronavirus. Even if you’re young, if a cytokine storm breaks out, then your body won’t be able to easily prevent it.

Find out more: Stroke Risk Factors and Symptoms

Should young people be concerned about coronavirus strokes?

Overall, the key is early detection. Doctors who spoke with The Washington Post said that many were late in coming forward. This was because they didn’t want to go to the doctor’s and risk catching the virus. However, the problem was that they were already infected.

If you have symptoms that are consistent with a stroke, then whatever you do, don’t delay in going for treatment. If you have a severe headache, changes in your vision, or tingling and paralysis in your face or limbs, then you should contact the emergency services immediately.

The fact that coronavirus could cause strokes is just one more reason why we should be taking extreme care in these difficult times.

  • Mao, Ling, et al. “Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study.” (2020).
  • Hoffmann, Markus, et al. “The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2 and the cellular protease TMPRSS2 for entry into target cells.” BioRxiv (2020).
  • Castellón, Roberto León, Juan Enrique Bender del Busto, and Luis C. Velázquez Pérez. “Afectación del sistema nervioso por la COVID-19.” Anales de la Academia de Ciencias de Cuba 10.2 (2020).
  • Han, Huan, et al. “Prominent changes in blood coagulation of patients with SARS-CoV-2 infection.” Clinical Chemistry and Laboratory Medicine (CCLM) 1.ahead-of-print (2020).
  • Zhang, Yan, et al. “Coagulopathy and antiphospholipid antibodies in patients with Covid-19.” New England Journal of Medicine (2020).
  • Mehta, Puja, et al. “COVID-19: consider cytokine storm syndromes and immunosuppression.” The Lancet 395.10229 (2020): 1033-1034.