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Large-Vessel Stroke Described in Young Adults With COVID-19

Five patients younger than 50 years presented with large-vessel stroke during two-week period in NYC

patient on a stretcher

THURSDAY, April 30, 2020 (HealthDay News) -- Cases of large-vessel stroke in individuals younger than 50 years are described in patients with COVID-19 in a case report published online April 28 in the New England Journal of Medicine.

Thomas J. Oxley, M.D., from Mount Sinai Health System in New York City, and colleagues reported five cases of large-vessel stroke in patients younger than 50 years presenting to a New York City Health System. All five were diagnosed with severe acute respiratory syndrome coronavirus 2 infection.

The researchers described one previously healthy 33-year-old woman who reported cough, headache, and chills lasting one week. During a period of 28 hours, she experienced progressive dysarthria with numbness and weakness in the left arm and left leg. Due to fear of COVID-19, she delayed seeking emergency care. She presented to the hospital with a National Institutes of Health Stroke Scale (NIHSS) score of 19, and computed tomography revealed a partial infarction of the right middle cerebral artery. During a two-week period from March 23 to April 7, 2020, four additional patients younger than 50 years presented with new-onset symptoms of large-vessel ischemic stroke; all were positive for COVID-19. In comparison, during the previous 12 months, an average of 0.73 patients younger than 50 years of age presented with large-vessel stroke every two weeks. The mean NIHSS score was 17, which was consistent with severe large-vessel stroke.

"Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes," the authors write.

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