Stroke is always a medical emergency – even during the Covid-19 crisis

Neurologists across the world are reporting a drop in the number of acute stroke patients seeking emergency care during the Covid-19 pandemic.
The likely reason is that patients are intentionally staying home because they fear coronavirus exposure at hospital emergency rooms.
Many are also under the impression that only Covid-19 associated cases are being prioritised in the hospital setting.
But stroke remains a disabling event, with a higher fatality rate than currently recorded coronavirus fatality.
Previous data estimates up to 360 South Africans are affected by strokes daily.

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About a third of those who suffer a stroke will die, and a quarter will be left with life-changing disability.
Dr Patty Francis, president of the Neurological Association of South Africa (NASA), Angels Initiative Steering Committee Member and lead stroke neurologist at Netcare Umhlanga Hospital, urges members of the public who experience symptoms of a stroke to go to their nearest emergency room without delay.
“Hospital emergency departments are now partitioned into specific triage areas for Covid-10 PUI (persons under investigation) and other patients. Extreme measures are in place to ensure that patients are safe from contracting the virus.
“All elements of acute stroke care are still available during the Covid-19 pandemic and patients who have symptoms of a stroke should seek immediate care at the nearest stroke ready centre,” said Francis.
Francis also highlights increasing reports of Covid related strokes.
As recently as April 22, Dr Thomas Oxley, a neurosurgeon at Mount Sinai Health System in New York reported five patients under the age of 50 presenting with stroke. None of them had any prior risk factor for stroke. Hence the strokes were attributed to Covid disease itself.
Prof Pamela Naidoo of the Heart and Stroke Foundation South Africa said that clinical information is crucially important in managing the complications of Covid-19.
“We await evidence from well-controlled studies to understand the pathogenic pathways for Covid-19 and stroke”.
A stroke occurs when oxygen supply to the brain is decreased by a blockage or damage to a blood vessel in the brain.
This causes brain cells to die. Large or critical strokes can be fatal or result in disability.
There is clear evidence of increased clotting caused by Covid-19 infection.
This may be a contributor to the apparent increase in stroke risk, although multiple factors are likely to be detected as research unfolds.
The chances of recovery from a stroke depend on rapid recognition that they are experiencing a stroke and getting them to an emergency hospital fast.
Francis acknowledges that with an estimated population of 58 million citizens, South Africa needs an average of 283 stroke hospitals and 60 comprehensive stroke centres.
Not every citizen will have an emergency facility within range. For such individuals, the message still remains: get rapid access to any local medical doctor closest to you.
Prof Naidoo said that having knowledge about the risk factors and prevention measures for stroke is important to reduce the burden of stroke in South Africa.
If you suspect a stroke, do the BEFAST test:

• Balance – Does the patient have a sudden loss of balance or co-ordination
• Eyes – Is there blurred vision or loss of vision
• Face – Smile and see if one side droops
• Arm – Raise both arms. Does one arm drift down?
• Speech – Repeat any sentence. Is there trouble speaking or understanding?
• Time – Time saved is brain function saved. A person loses 1.9 million neurons each minute in which stroke is left untreated.

For more information on stroke and Covid-19 visit the following websites:
Heart and Stroke Foundation South Africa: https://www.heartfoundation.co.za/stroke/
Neurological Association of South Africa: https://www.mynasa.co.za/
Covid-19 South Africa: https://sacoronavirus.co.za/