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Coronavirus may pose new risk to younger patients: stroke

Leana Soman, girlfriend of Ravi Sharma, in New York, during a videoconference with Sharma and her relatives, while he recovers in a rehabilitation center, on May 11, 2020. (Sarah Blesener / The New York Times)
Leana Soman, girlfriend of Ravi Sharma, in New York, during a videoconference with Sharma and her relatives, while he recovers in a rehabilitation center, on May 11, 2020. (Sarah Blesener / The New York Times)

NEW YORK - Ravi Sharma was cowering in his bed when his father found him. He had been coughing for a week and had decided to quarantine in his room. As a health emergency technician, I knew that he had probably become infected with coronavirus.

At the time, Sharma, 27, was unable to move the right side of her body and could only growl to communicate with her father. Her sister, Bina Yamin, on the phone from her home in Fort Wayne, Indiana, could hear the sounds she made.

"Call 911," he said to his father. "I think Ravi is having a stroke." He was right.

Over the next few hours, doctors at a Queens hospital did their best to undo a clot that blocked an artery in Sharma's brain. But the doctors were puzzled.

Sharma was too young to have a stroke. He exercised every day and had no diabetes, hypertension, or the kinds of diseases that can cause a stroke in young adults, which are rare in this population.

Neurologists in New York City, Detroit, New Jersey, and other parts of the country have reported a wave of cases like this. Now, many are convinced that unexplained strokes, also known as strokes or strokes, represent another insidious manifestation of COVID-19, the disease caused by the new coronavirus.

The cases add to the evidence that the coronavirus attacks not only the lungs, but also the kidneys, brain, heart, and liver. In rare cases, it appears to trigger an inflammatory syndrome that is life-threatening for children.

"We are seeing a surprising number of young people who have had a mild cough, or do not remember having viral symptoms, and are isolating themselves properly at home and suddenly have a stroke," explained Adam Dmytriw, a radiologist at the University of Toronto and co-author of an article describing patients who suffered COVID-19-related strokes. The article has not yet been peer reviewed.

Although many of those patients had diabetes and hypertension, none had heart risks known to increase the chances of having a stroke. Many were under the age of 65. For some, stroke was the first symptom of coronavirus infection, and they did not go to the emergency room for fear of exposure to the virus.

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Of the ten patients described in Dmytriw's article, two died because the coronavirus attacked their lungs, and two men (one 46-year-old and the other 55-year-old) died from strokes.

Doctors at the Mount Sinai Comprehensive Health System in New York have also seen an unusual number of young patients who suffered strokes and mentioned that they treated five of these patients for COVID-19 during a recent two-week span. Generally, patients under the age of 50 with this type of health problem come to the medical center every three weeks, according to Johanna Fifi, a neurologist, and her colleagues, in a letter that was published in the New England Journal of Medicine.

Four of the five patients were relatively healthy; Two in their thirties had no known risk factors for stroke. "We concluded that it had to be related to COVID-19," Fifi said in an interview.

Although strokes appear to affect a very small number of patients infected with COVID-19, they are believed to be related to a more widespread phenomenon that has emerged in seriously ill patients: excessive coagulation.

Some evidence suggests that the coronavirus could directly infect the endothelial cells that line the inside of blood vessels, causing lesions and inflammation that attract proteins that promote clotting, Cuker explained.

People who have been exposed to the coronavirus, or who are controlling the infection at home, should call their doctors if they experience chest pain and shortness of breath, which could indicate a clot in the lung, or pain, inflammation, redness and discoloration in the legs that could indicate the presence of a clot.

It was healthy, until it stopped being healthy

It was not until Sharma arrived at Jamaica Hospital on April 1 that the test was performed to identify if he had a coronavirus. But I knew I was at risk. He had spent weeks taking ambulance tour after tour, transporting elderly and sick patients from nursing homes to Brooklyn and Queens hospitals in February and March.

By mid-March, Sharma began to develop a dry cough and went to an emergency care clinic, where she was told that they had no evidence, but that she should stay home because she was probably infected.

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At the hospital, emergency room doctors took aggressive steps to restore the blood supply to the left side of his brain. They also diagnosed him with acute respiratory distress syndrome and found that Sharma's infected lungs were filling with fluid and that his blood oxygen levels were low. A test found that he had a coronavirus and an artificial ventilator or ventilator was placed on him.

The doctors were kind but honest with the family. "They told us that their chances of survival were 50-50. They didn't know if he would live or die, "Yamin recalled.

Over the next few days, while Sharma was still sedated, Yamin spoke several times with the doctors and nurses at the hospital, taking meticulous notes that he later shared with family members and The New York Times.

By April 18, Ravi had already managed to breathe easier on his own. The fever had subsided and her blood pressure and heart rate had stabilized. The next day he woke up, the ventilator was removed and he began to breathe without the aid of the device.

He was still unable to speak and did not know what had happened to him, but a nurse helped him hold the phone so the family could see him on FaceTime. "We couldn't stop crying. We just said, ‘Oh my God, Ravi, we love you. These are tears of happiness, "Yamin recalled.

Full recovery from a stroke can take months or even years, and Sharma is also recovering from the aftermath of COVID-19, such as fatigue and the loss of 50 pounds, he said in a video interview with The New York. Times.

However, in a very short time he has had a great recovery and his friends say that he is still the same Ravi as always: charming for those around him.

Sharma boasted of being everyone's "favorite patient" at the rehab center and that her quick recovery is due to the clinic staff secretly giving her chocolate milk and candy.

"I got the doctors to include ice cream as part of my diet," he said.

* Copyright: 2020 The New York Times Company

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Sam Conley is new to online journalism but she is keen to learn. She is an MBA from a reputed university. She brings together relevant news pieces from various industries. She loves to share quick news updates. She is always in search of interesting news so that she can share them as well to Sunriseread's readers who could enjoy them with their morning coffee.

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