EMSSTAT ambulance rushes in to the ambulance bay at Norman Regional HealthPlex during daylight.

Friday, May 29, 2020

The COVID-19 pandemic led people to staying home, but did staying home put some people at risk of suffering permanent deficits from life-threatening emergencies such as stroke?

Physicians at Norman Regional noticed a decrease in the number of acute stroke cases in the Emergency Department in March and April, and they aren’t alone in their findings. Hospitals in Oklahoma and across the country saw a decrease of nearly 40% nationwide. The decrease is assumed to be due to people staying home even with stroke symptoms because of the fear of contracting COVID-19, said Smaranda Galis, MD, neurologist and co-medical director of Norman Regional’s Stroke Center.

“The ‘Stay at Home’ messaging has led to an unfortunate miscommunication for stroke patients because time is brain, which means that without emergency treatment – strokes can be devastating,” Dr. Galis said. “Besides the fear of getting infected, it’s possible that some older patients, now isolated from their loved ones, may have milder stroke symptoms going unnoticed until getting worse. This is another reason to check often on our older loved ones, as either slurred speech or confusion may be picked up during a phone conversation, or a droopy face on video calls.”

Dr. Galis said Norman Regional’s advanced Stroke Center is fully equipped to safely treat stroke patients during the pandemic.

“Our core stroke medical team, including physicians from different specialties, has been constantly reading and reviewing reports and information from other centers that have experience with COVID-19 patients. We also met virtually with the larger Oklahoma State Stroke Systems Advisory Committee and are using this growing knowledge to adapt our protocols and consider different scenarios to be ready for,” Dr. Galis said.

Does COVID-19 Increase the Risk of Stroke for Younger People?

A sharp increase in the incidence of serious large-vessel disease strokes under the age of 50 was reported by Mount Sinai Health System in New York City in a letter to the New England Journal of Medicine, in which the health system described five cases of strokes in patients between the ages of 33-49 who tested positive for COVID-19 and presented over a two-week period, representing a seven fold increase over their usual rate.

Dr. Galis said the increase is attributed to the risk of thrombosis, or clotting, with this new virus.

Other health systems have also reported an increase of younger stroke patients due to COVID-19.

“Fortunately, we have not yet seen this trend in our community, but we are extremely vigilant given the cases reported by neurologists working in the hot spot areas,” Dr. Galis said.

It is known that certain health conditions can put someone more at risk for stroke than others, including high blood pressure, high cholesterol, diabetes, carotid artery disease, heart disease, and atrial fibrillation. Other factors such as having already experienced a prior stroke or heart attack, or a family history of stroke, can also put someone at a higher risk for stroke. COVID-19 seems to be a new addition to the list, said Courtney Stark, RN, BSN, stroke program coordinator.

Time is Brain

When a stroke happens, every minute counts. The first hours after a stroke are critical for restoring blood flow to the parts of the brain that are affected by the stroke.

Stroke is the fifth leading cause of death in the U.S. and the No. 1 cause of long-term disability, which is why it is crucial to call 911 at the first sign of stroke; even if the person is experiencing COVID-19 symptoms. A person needs to be at the hospital within 60 minutes of having a stroke to be evaluated and receive treatment for the best possible outcome.

Signs of stroke are “BE FAST” or:

  • BalanceSudden loss of balance, trouble walking or dizziness
  • EyesSudden vision changes with double vision or loss of vision in one eye
  • Face – Face drooping on one side
  • Arms – Arm weakness. Does one arm drift down when raised?
  • Speech – Slurred or strange-sounding speech
  • Time – Seconds matter. Call 911 immediately.

People should call 911 rather than drive themselves or a loved to the Emergency Department because stroke treatment can begin in the ambulance.

It is important that people track when they first noticed their symptoms and when they last felt ‘normal.’ It is also important for people to keep a current list of medications on hand to be able to provide to the paramedics and hospital staff. Reporting the ‘last-known normal’ time and providing a medication list will help the care team make the appropriate treatment decisions as quickly as possible.

Norman Regional is Here to Help

Norman Regional offers award-winning, nationally recognized stroke care and is certified as an Advanced Primary Stroke Center by The Joint Commission.

Baby Moxlie

Dr. Galis accepting the 2020 American Heart Association/American Stroke Association Get With The Guidelines – Stroke Gold Plus Quality Achievement Award at the International Stroke Conference in February in Los Angeles, California.

Some of the recent awards include the American Heart Association/American Stroke Association’s ‘Get With The Guidelines’-Stroke Gold Plus Quality Achievement Award for 2020, as well as the recipient of their Target: Stroke Honor Roll Elite Award for 2020. These awards mean that Norman Regional is providing the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

The stroke program also received the Women’s Choice Award for America’s Best Stroke Centers for the third time in 2020. This honor recognizes excellence in stroke care based on robust criteria that considers patient satisfaction and clinical excellence. 

Check out a video from the American Heart Association with a message from hospitals and stroke specialists throughout Oklahoma, including Dr. Galis and her other co-medical director of Norman Regional's Stroke Center Angela Carrick, MD, emergency medicine physician.