Traditional stroke treatments like clot-dissolving tPA and surgical removal of big clots in the brain are good choices as well when the stroke results from SARS-CoV-2 infection, investigators report.
Excessive blood clotting and stroke -- even in young, previously healthy people -- are among the myriad of effects the virus is having on people across the globe. Another effect is keeping people away from hospitals even when they experience signs of stroke, like sudden and particularly one-sided weakness in the face, arm or leg, say stroke specialists at the Medical College of Georgia and Augusta University Health System.
"What we know about COVID-19 and stroke is people need to be treated urgently and they tend to do really well with tPA and mechanical thrombectomy (clot removal) if they come in within a short time window," says Dr. David Hess, stroke specialist and MCG dean, who encourages those with signs of stroke for any reason to get to the hospital as soon as possible.
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Hess and Dr. Elizabeth Rutkowski, a neurologist whose expertise includes brain infections as well as stroke, are authors of a review paper in the journal Translational Stroke Research highlighting both established and emerging treatment options that may help improve stroke outcomes or reduce stroke risk in these unprecedented times when the extremely infectious SARS-CoV-2 has been added to the traditional risk factors for stroke like high blood pressure and diabetes.
They also have begun a five-year study to assess the overall neurological impact of SARS-CoV-2 infection long term in more than 500 Georgians.
Because signs of the virus' impact neurologically include not only stroke, but the loss of sense of smell, called anosmia; a reduced sense of taste, called hypogeusia; and brain involvement called encephalopathy that may impact consciousness and cause confusion and headaches, as well as seizures.
In fact, loss of smell can be an early or even lone indicator of SARS-CoV-2 infection. Whether it's a lasting loss is one of the many things the investigators want to learn. "The hypothesis may be that the people who have anosmia may be more at risk for developing cognitive and other neurological problems," Hess says.
The brain is a pretty direct target for the virus, which the Centers for Disease Control and Prevention says is mostly spread by human-to-human contact. When an infected individual coughs or sneezes in close proximity, a bystander's nasal passageway provides a pretty direct route for the virus to first make its way through the olfactory bulb in the front of the brain, which picks up and processes odors detected by cells in the nasal cavity, then to spread throughout the brain. The mouth affords a different route that can take the virus directly to the brain stem, and the neurologists say it's likely the virus could take both routes in one person.