What to Know About Cerebrovascular Disease and COVID-19

Risk Factor for Severe Illness and a Complication of the Infection

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According to the Centers for Disease Control and Prevention (CDC), adults who have cerebrovascular disease might be at an increased risk for severe illness from the virus that causes COVID-19.

Acute or chronic cerebrovascular disease can worsen the outcome of COVID-19. The infection may have a more severe effect on your long-term health if you already have cerebrovascular disease.

COVID-19 can lead to acute cerebrovascular events before the infection resolves, especially if you have preexisting cerebrovascular disease. This COVID-19 complication is associated with a worse prognosis and may cause lasting disability. 

It is important to avoid COVID-19 with underlying cerebrovascular disease

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Cerebrovascular Disease and COVID-19 Risk 

Having cerebrovascular disease does not predispose you to COVID-19 exposure. But if you are exposed to the virus, cerebrovascular disease is associated with a higher chance of becoming sick from the virus and of having a worse disease course. 

Stroke is one of the complications of COVID-19 infection, and underlying vascular risk factors, including cardiovascular and cerebrovascular problems, increase the risk of this complication.

Cerebrovascular disease is the presence of many small strokes in the brain, usually due to atherosclerosis, which is narrowing and a buildup of plaque in the blood vessels. It can be identified with brain imaging studies. It typically causes gradual problems—memory impairment, difficulty concentrating, slowed thinking, and personality changes.

The condition is associated with longstanding risk factors that include hypertension (chronically high blood pressure), smoking, high cholesterol levels, and diabetes.

Many of the risk factors that lead to cerebrovascular disease—hypertension, smoking, and diabetes—also independently increase the risk of becoming very sick from exposure to COVID-19.

Complications of Cerebrovascular Disease and COVID-19

Cerebrovascular complications of COVID-19 infection are associated with a prolonged recovery and lasting neurological damage. This complication is more likely to affect people who have preexisting cerebrovascular disease, but it can affect people who don’t have this problem at all.

If you develop cerebrovascular complications of COVID-19, the symptoms can develop suddenly and may be more severe than chronic cerebrovascular disease symptoms.

Cerebrovascular complications of COVID-19 infections include:

  • Small ischemic strokes: Ischemic strokes are caused by an interruption of blood supply in the arteries of the brain. Sometimes, one or more small strokes can occur due to a COVID-19 infection.
  • Large ischemic strokes: Large strokes may cause severe disability and are less common in COVID-19 than small strokes.
  • Hemorrhagic strokes/intracerebral hemorrhage (ICH): Hemorrhagic strokes are bleeds in the brain. They are an uncommon complication of COVID-19, and they generally have a severe impact.
  • Cerebral venous thrombosis: Blood clots in the veins of the brain can cause headaches, confusion, and personality changes. This is a rare complication of COVID-19.
  • Encephalitis/encephalomyelitis: This type of brain inflammation has been seen more often in children infected with COVID-19 than adults. It may be associated with small strokes. Studies early in 2021 suggest children with this complication tend to have a good recovery, with resolution of the neurological effects after the infection resolves.

These complications affect between 0.5% and 5% of people who have COVID-19. Cerebrovascular complications of COVID-19 can be life-threatening, especially for adults. In one study, the in-hospital mortality rate for COVID-19-associated ischemic stroke was 38.1%, and it was 58.3% for ICH.

Risk Factors 

The risk factors that make it more likely to develop cerebrovascular complications of a COVID-19 infection include already existing cerebrovascular disease, as well as heart disease and hypertension, which also predispose to cerebrovascular disease without COVID-19 infection. 

Researchers suggest that the infection-induced inflammation triggers excessive blood clotting proteins that contribute to blood clot formation and obstruction in blood flow throughout the body.

Preexisting atherosclerosis in the brain makes these blood vessels more susceptible to blockage from inflammation and blood clots that develop due to this infection. 

Cerebrovascular Disease Treatments and COVID-19

The treatments used for managing COVID-19 infection and the treatments used for managing cerebrovascular disease do not interfere with each other in any harmful way. 

Sometimes blood thinners are used during treatment of COVID-19 infection if the patient is at high risk of developing a blood clot. If you are already taking blood thinners because of your cerebrovascular disease, your healthcare providers would consider this when deciding whether you should continue to take the same blood thinner or change to another one. 

Blood pressure control is very important in the setting of acute cerebrovascular complications. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have been used effectively in the hospital for people who have cerebrovascular complications of COVID-19.

Long-Term Effects and Recovery 

People who have a cerebrovascular event associated with COVID-19 have longer duration of hospitalization and worse functional outcomes at discharge than people who experience cerebrovascular events that are not associated with COVID-19.

Cerebrovascular events can cause behavioral changes, weakness, vision loss, and memory and communication problems. Generally, these effects are long-lasting but can usually improve to some degree over time. Since COVID-19 is a relatively new infection, the lasting effects of COVID-19-associated cerebrovascular disease are unknown.

Rehabilitation is beneficial for optimizing function that’s impaired by cerebrovascular disease. Unfortunately, we don’t yet know how long people remain immune to COVID-19 after recovering from the infection. Many physical therapy and rehabilitation facilities have reduced their in-person appointments to prevent the spread of infection.

As a result, there is a chance that you would have some of your rehabilitation with telehealth services rather than in person. 

Frequently Asked Questions 

Can I get the COVID-19 vaccine if I have cerebrovascular disease?

Yes, the vaccine is recommended and there is no contraindication to getting the vaccine if you have cerebrovascular disease. Having cerebrovascular disease is not associated with any adverse effects related to the COVID-19 vaccine or to any vaccine. 

Should I start taking blood thinners if I have been exposed to COVID-19?

Do not make any changes to your medication regimen. If you are not already taking blood thinners for your cerebrovascular disease, do not start unless you have specific instructions from your practitioner. Even over-the-counter blood thinners can cause bleeding, so they should not be used unless recommended by your healthcare provider. 

Will COVID-19 cause me to have new neurological effects of my cerebrovascular disease?

Normally, this infection should not cause new neurological symptoms unless you experience a complication. Such a complication necessitates urgent medical care. If you develop weakness, trouble communicating, confusion, numbness, vision changes, or convulsions, seek medical attention right away. 

If I have cerebrovascular disease, is there anything I can do to avoid getting sick in case I catch COVID-19?

You can take steps to stay healthy and reduce your risk of complications from COVID-19. Stop smoking if you are a smoker—consider seeking medical help with this. Talk to your healthcare provider about maintaining a healthy blood pressure, cholesterol level, and blood sugar level. Medications and consistent lifestyle strategies can help reduce your risk of illness.

Do I have to be admitted to the hospital if I catch COVID-19?

No, you do not need to go to the hospital unless you feel sick. Many people who get COVID-19 recover at home. With cerebrovascular disease, you can have a mild case of COVID-19 infection, and you might not have any symptoms of the infection at all.

How to Stay Safe 

If you have cerebrovascular disease, your health could be severely affected by COVID-19 infection. Staying safe is hard. It means staying away from anyone who could be an asymptomatic carrier.

This might mean missing out on fun events, like family gatherings. It also means wearing a mask at times when you could be potentially exposed (such as at the grocery store or the healthcare provider’s office). 

You should continue to take all of your medications as prescribed and see your healthcare provider, whether in person or with telehealth visits.

A Word From Verywell

While they aren’t frequently related, there are a number of complex links between cerebrovascular disease and COVID-19.

If you already have cerebrovascular disease, it’s vital to stay safe and do what you can to avoid catching COVID-19. Your underlying cerebrovascular disease could put you at a higher risk of having a more difficult bout of illness if you catch the infection. 

And if you develop cerebrovascular complications due to a COVID-19 infection, you could have a prolonged recovery, potentially with lasting health issues. Rehabilitation can include physical therapy, speech and swallow therapy, and more—and can greatly improve your outcome.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.