As the country continues to fight a surge in the COVID-19 pandemic, hospitals are reporting a decline in the number of stroke cases arriving in their emergency rooms. Some health experts suspect that fear of COVID-19 may be causing people to avoid going to the hospital or calling 911 for non-COVID related medical emergencies, like stroke.
But what if COVID-19 is the cause of your stroke? When symptoms of COVID-19 are often rattled off, a stroke usually isn't on the top of the list, but Dr. Donald Higgins, an optometrist from Plainville, realized that his double vision and dizziness following a COVID-19 diagnosis was a concern.
COVID-related strokes occur because the virus produces a strong inflammatory reaction from the body, which can cause blood clots, possibly leading to a stroke. More generally, COVID-19 seems to trigger cardiac events: heart attack, dangerous heart rhythms, and more.
It is still unknown if the virus itself stimulates blood clots to form, or if they are a result of an overactive immune response to the virus.
Higgins had tested positive for COVID-19, and other than some fatigue he felt it was similar to a bad cold. However, on day eight of his diagnosis, he was not feeling well. After watching a movie, he had a sudden onset of diplopia, or double vision.
He decided to lie down for an hour with hopes it would go away. However, it got worse.
"I hadn't previously used the services of UConn Health, but was considering moving my care there," says Higgins. "I'm glad I did, because UConn Health saved my life as I knew it."
Jackie Strickland, a Registered Nurse in the Emergency Department, quickly recognized that Higgins was having a stroke, and an alert was called to assemble the stroke team.
"I basically stumbled through the Emergency Department doors and was impressed from that second on," says Higgins. "Jackie, the triage nurse, asked for my driver's license, and in seconds they were there with a wheelchair. It was her recognition that I was having a stroke and that time was of the essence that saved my life."
After a head CT Scan, Dr. Daniyal Asad, neurology resident under the direction of Dr. Fernanda Wajnsztaju, neurologist at UConn Health, gave the patient tissue Plasminogen Activator (tPA) for a blood clot. When administered quickly after stroke onset, tPA helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment.
"Upon my arrival, everything moved so quickly, I was in the CT scan and given tPA within what seemed like 10 minutes," says Higgins.
Higgins had a dense left Internuclear ophthalmoplegia (INO), suggesting a stroke affecting the left medial longitudinal fasciculus (MLF). The tPA was administered and his deficits resolved within an hour.
"The management of stroke patients is a multidisciplinary team effort. Immediate treatment is essential because, with every second that goes by, there is potentially less brain tissue that can be saved," says Asad.
A stroke that affects certain areas of the brain can also affect eyesight. Strokes can cause vision problems including visual field loss, double or blurry vision, and can also affect visual processing.
Many people are familiar with FAST (face, arm, speech, and time) as symptoms of a stroke; however, eyes are the E on BEFAST, and generally a less-known symptom of stroke. Most people are still learning the BE (balance and eyes/vision change) as an addition to stroke symptoms, says Jennifer Sposito, R.N., M.S.N, stroke coordinator at the UConn Health Stroke Center.
Luckily, a subsequent MRI showed there was no acute damage to Higgins' brain.
"I was on my knees thankful when the MRI showed no damage. I would have lost my livelihood," says Higgins.
Even though he already had COVID, Higgins recognized the highest safety measures are in place for COVID at UConn Health – critical information for anyone worried about seeking emergency medical care out of fear of contracting the virus.
"From the beginning until the time I left, and even in subsequent phone calls, everyone I came in contact with at UConn Health were the nicest people," says Higgins. "I will be indebted to UConn Health for the rest of my life."
Higgins had never missed a day of work in 38 years, and says this has been a life-changing experience which has made him a strong proponent of receiving the COVID-19 vaccine.
"These cases remind me why we do what we do," says Asad.
Never ignore an emergency such as a stroke or heart attack. TIME IS BRAIN: the sooner you are evaluated and treated, the greater your odds that what could be a major stroke will be less serious, increasing chances of a successful recovery.
UConn Health practices strict COVID-19 protocols to protect staff and patients based on CDC guidelines and it is safe to come to the emergency room.
