In the past two weeks, doctors in the United States, including those in Buffalo, have noticed a new and potentially devastating link between stroke and COVID-19. And it is occurring in an unexpected population.

“We’re seeing an increased percentage of younger, typically female, stroke patients,” says Elad I. Levy, chair of neurosurgery and professor in the departments of Neurosurgery and Radiology at the Jacobs School of Medicine and Biomedical Sciences at UB, co-director of the Gates Stroke Center and a clinician at University at Buffalo Neurosurgery (UBNS).

Levy says that based on conversations he has had with medical colleagues in hospitals downstate, there could be an increase of up to 20% of stroke incidence during the apex of the coronavirus pandemic.

This is surprising because the novel coronavirus has been seen as primarily a respiratory illness, like influenza. But it is becoming increasingly evident that COVID-19 affects the kidneys, heart, intestines, liver and brain, in addition to the lungs.

In a stroke, a clot that has formed in a blood vessel breaks off and travels through the circulatory system to the brain.

Levy says patients in the newly recognized stroke subgroup typically show up at the emergency department with stroke symptoms, and usually have not been tested for the virus. Emergency stroke treatment is initiated as tests are sent, and after the patients are treated results show up as positive several days later.

The reasons for the coincidence of stroke and COVID-19 are still unclear, Levy says.

“When you ask ‘Why?’ ─ that is the billion-dollar question,” he says.

One possible reason, he says, is that these patients have fevers and are dehydrated, which causes the blood to thicken. In addition, pre-existing conditions, such as obesity, smoking and an increasing sedentary lifestyle during quarantine, are “factors that enhance every single risk factor for stroke,” he says.

This new type of stroke patient requires new treatment protocols in the hospital, Levy says. They need to be kept in a dedicated room so as not to infect other patients in the stroke ward, for example. Medical staff need to have dedicated personal protective equipment and intubation equipment, as well.

Once they are stabilized, these patients are put through a battery of tests, he says.

Levy says doctors in Buffalo are working collaboratively with doctors all over the country to learn more about the link between COVID-19 and strokes. In addition, he and his colleagues in Western New York are collecting information on stroke patients who test positive for COVID-19.

“There are many questions we need to ask,” he says. “This is ‘hot off the press.’”