Q: Should I call 911 if I suspect a stroke?
Yes, yes, and yes! Stroke numbers have been down throughout the pandemic, and it’s not because fewer people are having strokes. People are waiting out of fear of getting infected with COVID-19 at the hospital. When they do call for help, they are arriving in worse shape and having poorer outcomes. If you’re experiencing symptoms of stroke, like slurred speech or weakness on one side of the body, don’t second guess yourself at home. Call 911 and get help immediately.

Q: Why is time so important when it comes to stroke?
Every minute you wait to treat stroke, you lose brain cells. That’s why doctors say, “time is brain.” In addition, certain treatments such as tissue plasminogen activator (tPA), a clot busting drug, is only effective within four and a half hours of a stroke. For a smaller category of patients, a more involved procedure called thrombectomy is most effective within six hours of symptoms. Delayed treatment too often results in more disability, slower recovery, and reduced overall function.

Q: What are the symptoms of stroke?
A helpful acronym is BE FAST.

• B stands for balance (dizziness, loss of balance or coordination)
• E is for eyes (trouble seeing out of one or both eyes)
• F is for face (a lopsided smile or facial weakness)
• A is for arm (difficulty raising both arms equally)
• S is for speech (trouble speaking)
• T is for time (call 911 immediately)

Other symptoms include trouble walking, a severe headache, and confusion.

Memorize these symptoms and educate others about them and call 911 as soon as you experience them or see them in others.

Q: Are hospitals safe?
Yes. Hospitals are taking every precaution to keep patients safe. Everyone—patients and staff alike—wear masks at all times. Patients who come in without masks are given one. Stroke patients are asked about symptoms of COVID-19 such as a cough or fever. They may also be tested for COVID-19, and if negative they are treated separately from COVID-19 patients.

Q: Will I get appropriate care at the hospital?
Absolutely. Every patient in the emergency department receives the attention and treatment he or she needs. All hospital personnel are still working and coming into the hospital. Do not stay at home for fear of not being treated. Even if you’re in doubt, still call 911 and let the dispatcher decide whether you need to come into the hospital. Don’t try to make that decision on your own.

Q: What if I have symptoms of COVID-19 and then have a stroke?
Call 911. Both conditions are serious, but stroke is more urgent because certain treatments are only effective within four and a half hours of the start of symptoms. When speaking to the 911 operator, tell the dispatcher about all your symptoms, including those related to COVID-19. You may be asked about COVID-19 symptoms several times on the trip from your home to the hospital as well as at the hospital.

Q: How will my stroke and COVID-19 be treated at the hospital?
Anyone who comes to the hospital is assessed for COVID-19. If you’re having a stroke, the assessment happens at the same time you’re being evaluated, diagnosed, and treated for stroke. Either you or someone with you should know your risk factors for COVID-19 and whether you’ve had any symptoms such as fever, chills, cough, or shortness of breath, and if so, for how long.

Q: Could I have a stroke caused by COVID-19? 
Infection and stroke are linked in several ways. If you’re bedbound because of an infection or a fever, you’re more likely to form clots in your legs, which can travel to the lungs, heart, or brain. If a clot gets to the brain it causes a stroke. Infection itself can thicken blood, which also could cause a clot to form. Early indications suggest that patients who have a stroke associated with COVID-19 may be younger and not have any of the typical stroke risk factors such as high blood pressure or high cholesterol. They also may have more serious outcomes. Whether this is because of intrinsic qualities of COVID-19 is not yet known, but many institutions are working to gather more information. 

Q: What should I do if I have symptoms of COVID-19 and am at risk for stroke?
Contact your doctor who can advise you about next steps, which may include a visit via telehealth or an in-person appointment. If you are advised to stay home, shelter in place for 14 days. Don’t leave the house, and quarantine yourself from other members of the household. Treat and pay attention to your symptoms such as dry cough and fever and contact your doctor if they worsen. A fever and infection can thicken your blood and increase the risk of blood clots, which can cause a stroke.

Q: How do I know if I’m vulnerable to stroke?
Established risk factors include obesity, smoking, uncontrolled high blood pressure and diabetes, and heart disease. Factors that may be out of your control include not having access to health care or healthy food; job; family; or economic-related stress; and lack of education about stroke risks and symptoms. If you have any of these risk factors, reach out to your doctor for help.

Q: How can I prevent a stroke?
Taking care of yourself is so important during this time. Check in with your doctor regularly via telehealth and be sure to manage and control any risk factors for stroke such as high blood pressure and diabetes. If you have high blood pressure, you should own a home blood pressure cuff, and monitor yourself several times a week to know whether you’re in the right range. The ideal blood pressure is 120/80 mm Hg. If you’re overweight, ask your doctor for help in adjusting your diet and activity level to lose weight. If you smoke, talk to your doctor about cessation programs or medication to help you quit. Do what you can to stay active. Being sedentary can increase the risk of blood clots. Be sure to have an adequate supply of any medications you take, especially for high blood pressure and diabetes.

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COVID-19 (Coronavirus) and Neurologic Disease Resource Center