Covid is a strong risk factor for stroke in young patients: Dr Pramod Krishnan

In an interaction with ETHealthworld, Dr Pramod Krishnan, Consultant and HOD Neurology, Manipal Hospitals, talks about the increased risk of stroke even in healthy individuals.

Q: Research has shown that Covid patients are at an increased risk of covid. What have been your observations?
Dr Pramod Krishnan:
We are seeing a definite trend and association between Covid-19 and stroke. Covid is a very strong risk factor for stroke, especially in young patients.

We have had patients come with stroke without having any Covid symptoms and then as part of our procedure when we test the patient, the test result comes out as Covid positive.

We have seen patients across gender, across age groups and in seemingly healthy people who do not have any routine risk factors of stroke i.e., hypertension, diabetes or cholesterol and yet having a stroke in the context of Covid.

Q: In your patients, what has been the prevalence of Covid associated stroke in the asymptomatic patients?
Dr Pramod Krishnan: Stroke in Covid can happen without the standard Covid symptoms. About 80 per cent of the stroke patients that we have seen do not have Covid symptoms like fever or respiratory symptoms but test Covid positive.

These are also the patients who in our opinion wouldn’t be straight forward patients for stroke. They are not elderly, they are not having the usual risk factors and yet have suffered a stroke.

We have now learnt to suspect Covid in every stroke patient that we see. It has become a mandatory procedure to check any stroke patient for Covid even if there is no fever or respiratory symptoms.

Q: What is causing the rise in stroke cases in Covid patients?
Dr Pramod Krishnan: In people infected with Covid, their blood tends to have a strong clotting tendency. We have noticed that the virus tends to form clots which can block some of the blood flow to the brain. So we are seeing large vessel occlusion and micro occlusion in covid patients.

Stroke also appears to be a delayed effect of Covid. The strong clotting tendency in the blood can last for several weeks after Covid has subsided.

For severe Covid patients, we are advising that there should be blood thinners at least for 2-4 weeks depending on the severity of their disease. It is that one month period after Covid when most of these delayed complications happen- be it a stroke or heart attack.

The combination of air pollution, winter season and Covid will contribute to an increase in stroke but the dominant player remains Covid. And, if patients have additional risk factors like if they are already a diabetic, hypertensive or had serious strokes or heart attacks, the risk of stroke rises exponentially.

Q: What are the other neurological disorders being detected in Covid patients?
Dr Pramod Krishnan: We are seeing an entire range of neurological disorders starting from facial palsy called bell’s palsy which has become much more common. We are seeing patients having spinal cord problems, encephalitis, and encephalopathy, because of Covid infection.

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