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An Emerging COVID-19/Stroke Connection

The headlines are alarming: Young and middle-aged people with coronavirus disease 2019 (COVID-19) are having strokes. Most are adults who had no known preexisting conditions but end up in the hospital fighting for their lives.

To understand why this is happening, and why it is important for anyone who might be experiencing a stroke to get medical attention immediately, we talked to UNC Health cerebrovascular neurosurgeon Deanna Sasaki-Adams, MD, and UNC Health interventional cardiologist Ravish Sachar, MD.

Stroke Basics

A stroke is a sudden interruption of your body’s blood supply to the brain. There are two main types of strokes: ischemic and hemorrhagic. Most strokes are ischemic, caused by a blockage of a blood vessel. The blockage doesn’t allow nutrients such as oxygen and glucose to get to the brain, which causes brain cells to die.

A rupture of a blood vessel causes hemorrhagic strokes. The rupture can be very small within the brain tissue, which forces blood into the tissue, or an aneurysm, a weakened area in an artery, can rupture and pool blood into the space outside of the brain.

Because each part of the brain controls certain functions, the results of a stroke will differ depending on which part of the brain is damaged.

The COVID Connection

While the numbers are not high, the COVID-19 patients who experience a stroke tend to have the deadliest form of ischemic stroke called a large vessel occlusion. This type of stroke, a blockage in one of the major arteries of the brain, can affect the parts of the brain responsible for movement, speech and decision-making.

Reports of these strokes in young and middle-aged adults across communities with surges of COVID-19 cases have puzzled doctors. Doctors suspect the strokes in COVID-19 patients are a result of the virus causing blood clots throughout the body, but more research is needed.

“It does appear that patients infected with the COVID-19 virus have a higher risk of thrombosis, or blood clots, but we don’t know why,” says Dr. Sachar. “The reason these clots are a problem is because once they develop, they stop blood flow to the body’s tissues and organs. If the tissues and organs, including the brain, don’t get blood flow, they don’t get oxygen. And if they don’t get oxygen, they die.”

What to Do for Signs of Stroke: Seek Help Fast

If you are experiencing signs of a stroke—whether you have COVID-19 or not—every moment counts, and it is critical to get emergency medical care fast.

Signs of a stroke include:

  • Speech problems (slurred speech, inability to understand or produce language)
  • Weakness or numbness on one side of the body
  • Vision issues (double vision, inability to see or process what you’re seeing)
  • Impairment of motor activity, like the ability to walk normally
  • Confusion

Lack of blood to the brain causes brain cells to begin dying within minutes, and even 15 minutes can mean the difference between disability and a normal life moving forward.

Some patients with stroke symptoms have delayed going to the emergency department because they’re afraid of going into a healthcare environment during COVID-19, Dr. Sasaki-Adams says, but healthcare facilities are taking many precautions to keep their spaces disinfected and safe, and an untreated stroke is incredibly dangerous.

“You can potentially reverse damage to the brain completely if you get in early enough,” she says.


For the latest information on COVID-19, visit the CDC website and the UNC Health COVID-19 Resources page, and follow UNC Health on Twitter, Facebook, Instagram and YouTube.