Much has been discussed about the respiratory complications of COVID-19. However there is suggestion of neurologic sequela from the infection as well. SARS-CoV-2 has been found to directly invade brain cells, called neurons. However unlike other coronaviruses which can cause brain inflammation, called encephalopathy, mild COVID-19 tends not to incite this reaction. Of interest, patients who have died of COVID-19, on autopsy, do have some inflammation in their brain, but it is less clear if and when this would happen in mild or asymptomatic cases.
It is unclear how the virus gains access to the brain. While many patients lose some taste and smell with infection, it is uncertain if this is the route of cerebral penetration. However there has been some media publicity, that even minimally symptomatic people could be dying of strokes in droves. The Washington Post published such a clam in April: This is a largely unfounded claim. On the contrary, during this pandemic, many stroke centers have experience significant reductions, as opposed to increases, in strokes. A recent study found a 39% stroke reduction nationwide. In one large healthcare system treating thousands of COVID-19 patients, only 0.9% of these patients had imaging-proven stroke. Of interest, there also has been a nationwide 38% reduction in heart attacks.
This is an interesting finding, because other respiratory infections with sepsis (infection entering the blood stream), have up to a 5-fold increase in ischemic stroke in the first two weeks. Additionally, up to a 3rdof all-comer stroke patients may have had some sort of infection in the preceding week. However in mild COVID-19 disease, there essentially no associated risk.
Overall, the pathophysiology of COVID-19 is still poorly understood. However, young people with mild COVID-19, and otherwise no cardiac risk factors, have a low risk for stroke. Of course, severe COVID-19 is a different story Sensationalism is harmful. Increased rates of anxiety, depression and suicide have been associated with lockdowns during this pandemic. There have been financial ramifications. Exacerbating a fear of strokes, in an already strained healthcare system, may be irresponsible.