This is very alarming: Young, healthy people barely sick with covid-19 are dying from strokes https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients/

The stroke patient’s chart appeared unremarkable at first glance. He was male, took no medications and had no history of chronic conditions.

He had been feeling fine, hanging out at home during the lockdown like the rest of America, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head.

Dr. Oxley gasped when he got to the patient’s age and covid-19 status:

44 years old, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the virus. The median age for that type of severe stroke is 74.

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before.

On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot.

As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.

Reports of strokes in the young and middle-aged — not just at Mount Sinai but in many other hospitals in communities hard hit by coronavirus— are the latest twist in our evolving understanding of covid-19.

Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe — impacting nearly every major organ system in the body.

Stroke, a sudden interruption the blood supply, is a complex problem with numerous causes and presentations. The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke.

Known as large vessel occlusions or LVOs, they can obliterate large parts of the brain responsible for movement, speech and decision-making in one blow because they are in the main blood-supplying arteries.

Many researchers suspect strokes in novel coronavirus patients may be a direct consequence of blood problems that are producing clots all over some people’s bodies.

Many doctors expressed worry that as the NYC Fire Dept was picking up four times as many people who died at home as normal during the peak of infection that some of the dead had suffered sudden strokes. The truth may never be known because so few autopsies were conducted.

Eytan Raz, an asst professor of neuroradiology at NYU Langone wonders whether they are seeing more young patients because they are more resistant than the elderly to the respiratory distress caused by covid-19: “So they survive the lung side, and in time develop other issues.”

Pascal Jabbour, a neurosurgeon at Thomas Jefferson University Hospital said many of the cases he’s treated have unusual characteristics. Brain clots usually appear in the arteries, which carry blood away from the heart.

But in covid-19 patients, he’s also seeing blood clots in the veins, which carry blood in the opposite direction and are trickier to treat. Some patients are also developing more than one large clot in their heads, which is highly unusual.

The first wave of the pandemic has hit the elderly and those with heart disease, diabetes, obesity or other preexisting conditions disproportionately. The covid-19 patients treated for stroke at Mount Sinai were younger and mostly without risk factors.

On average the covid-19 stroke patients were 15 years younger than stroke patients without the virus.

“These are people among the least likely statistically to have a stroke,”physician-researcher J Mocco of Mount Sinai said.

Mocco, who has spent his career studying stroke and how to treat it, said he was “completely shocked” by the analysis. He noted the link between covid-19 and stroke “is one of the clearest and most profound correlations I’ve come across.”