COVID-19 and stroke: IGEA neurologist Charles Gellido, MD, shares insights and risk-reduction strategies
Many COVID-associated strokes have occurred in people who had risk factors for stroke before they contracted COVID-19.
Stroke is among the most devastating potential complications of COVID-19, but neurologist Charles Gellido, MD, says that people can take effective steps to reduce their risk for the cerebrovascular event and the damage it causes.
“The best way to avoid coronavirus-related strokes obviously is to avoid infection with the virus itself, and vaccination is the cornerstone of COVID-prevention efforts,” said Dr. Gellido, who practices with IGEA Brain, Spine & Orthopedics. The neurologist noted that while COVID vaccination rates tend to decline with age, strokes and the other blood-clotting complications of the coronavirus are not limited to older people, but also have been seen in younger and middle-aged adults.
At the same time, he added, many COVID-associated strokes have occurred in people who had risk factors for stroke before they contracted COVID-19. “Hypertension, obesity, uncontrolled diabetes and smoking all significantly increase the chances that a person will experience a stroke, and it appears that many patients who had a stroke following infection with the coronavirus had one or more of these risk factors. This is why controlling blood pressure and blood sugar, maintaining a healthy weight and not smoking are so important for all people,” the neurologist added.
In a recent interview, Dr. Gellido outlined what the medical community has come to know about the interaction between COVID-19 and stroke. He also discussed how he and his colleagues at IGEA Brain, Spine & Orthopedics — a multi-location and multi-disciplinary practice that includes neurology, neurosurgery, neuropsychology and orthopedic specialists — treat stroke and manage its aftermath.
Stroke and COVID-19: Emerging Data, Enduring Questions
An estimated 1% to 5% of patients hospitalized for COVID-19 infection have an acute stroke, Dr. Gellido noted, adding that this statistic underscores the importance of conducting COVID-19 testing on people who are brought to the hospital with an acute stroke or who are in the Emergency Department with stroke symptoms.
The neurologist added that it is important for all people with COVID-19 to be vigilant for stroke symptoms, whether or not they were hospitalized. “Stroke may occur within a week of being infected and may remain a risk even three or four weeks after testing positive for the virus. Despite feeling better after the infection seemingly has subsided, patients may remain in what we call a hypercoagulable state, meaning that their blood may still be prone to clotting due to COVID-19,” he explained.
Researchers have yet to fully determine why people suffer from stroke due to the COVID-19 virus, Dr. Gellido said.
“There are several proposed explanations. One of the most important focuses on vasoreactivity, or the ability of blood vessels to expand or contract in step with the body’s needs. The thought is that this ability is impaired in COVID-19, while the virus also leads to activation of proteins called complement and an enzyme, thrombin, that contribute to formation of blood clots. As a result, arteries can become blocked, leading to ischemia – an inadequate supply of blood reaching an organ – and infarction, which is local tissue death caused by ischemia. Large areas of infarction are prone to hemorrhage,” Dr. Gellido explained. He added that while platelet counts and other blood markers that often indicate clotting problems may be within the normal range in COVID-19 patients experiencing these issues, those people often have elevated levels of two other clotting markers, D-dimer and fibrinogen, as well as an abnormal partial thromboplastin time, or PTT.
Treating Acute Stroke
The American Heart Association and American Academy of Neurology have published guidelines on emerging treatments for stroke in patients with COVID-19 infection, Dr. Gellido said.
The main means of treating acute strokes are to administer intravenous “clot-busting” medicines known as thrombolytics or to remove the clot in a minimally invasive procedure called an endovascular thrombectomy, he explained. In the procedure, a specially trained surgeon introduces a catheter into the vascular system, advances it to the clot under imaging guidance, and then secures and removes the clot. (Two neurosurgeons at IGEA Brain, Spine & Orthopedics have been trained in and perform this neuroendovascular procedure.) Dr. Gellido noted that patients must meet specific criteria to be eligible for each approach, with — for example — time since onset of symptoms being a major consideration in determining if a patient is a candidate for thrombolysis with an intravenous medicine.
Whether by administering a medicine or performing a surgical procedure, the goal is to restore blood flow to the brain, Dr. Gellido said, noting that this is true whether or not the stroke is associated with COVID-19. “There is no specific or added treatment for people with COVID experiencing an acute stroke,” he added.
Patients discharged from the hospital typically go home on anticoagulation medication to prevent development of further blood clots. This treatment is particularly important in people whose D-dimer blood levels remain extremely elevated, Dr. Gellido explained, adding that neurologists generally prescribe one or two antiplatelet-coagulation agents, or sometimes use a combination of medications.
“Regular follow-up with your neurologist in the weeks and months following a stroke is vital, and can help to identify and address issues that otherwise could lead to secondary complications,” said Dr. Gellido, whose practice encompasses caring for post-stroke patients and people with a variety of other neurological conditions.
“As with so many aspects of COVID-19, the risks of an associated stroke are frightening and not yet fully understood. However, we are making tremendous strides in the research arena and with the clinical experience we have gained since early 2020. In the near future, more information will be published, and more evidence-based guidelines will be implemented. For now, it is important for people to realize that steps such as controlling blood pressure, blood sugar and weight can reduce their overall risk for stroke, while preventing COVID-19 infection through vaccination and other means can help them avoid COVID-associated stroke and its major impact on one’s life,” Dr. Gellido emphasized.
Charles Gellido, MD, is a board-certified neurologist at IGEA Brain, Spine & Orthopedics who subspecializes in nerve and muscular disorders. An expert in his field for nearly 20 years, Dr. Gellido has held prominent roles within the neurology departments of the organizations in which he has practiced. Aside from serving as attending neurologist at Montefiore Medical Center in the Bronx, N.Y., Dr. Gellido previously served as director of the Nerve and Muscle Disorders Unit within the Jacobi Medical Center, an affiliate of the Albert Einstein College of Medicine, where he completed his residency and remains a faculty member today.
After graduating with a bachelor of science degree in biology from the University of Santo Tomas College of Science in the Philippines, Dr. Gellido earned his medical degree at the Faculty of Medicine and Surgery of the same university. Upon graduation, he completed residency training in the Department of Neurology at the Albert Einstein College of Medicine in the Bronx before interning at the Cabrini Medical Center, an affiliate of the Mount Sinai College of Medicine. After his residency, he had his fellowship training in electrodiagnostic medicine/clinical neurophysiology at Montefiore Medical Center.
Despite maintaining a very busy clinical practice, Dr. Gellido remains committed to advancing scholarship within his field and has authored multiple publications in peer-reviewed journals.
At IGEA, Dr. Gellido practices with several board-certified neurosurgeons, a board-certified orthopedic surgeon, a board-certified neuropsychologist and other clinicians. With offices in Paramus, Union, Florham Park, Hazlet, North Brunswick, Jersey City, Bedminster and New York City, IGEA offers comprehensive, multidisciplinary care to patients experiencing a wide variety of neurological and musculoskeletal conditions and complaints.
To schedule an appointment with Dr. Gellido or one of the practice’s other physicians, or to learn more about IGEA, call 866-467-1770