Woman in Africa survives double whammy of Ebola, stroke

Health care workers prepare to treat patients with Ebola virus at a treatment center in West Africa. (Paul Dhillon)

A middle-age woman in Africa who became infected with Ebola suffered a stroke during her bout with the virus but managed to survive both maladies, according to a new report of her case.

The woman's case suggests that Ebola complications could include stroke, but more research is needed to say for sure, the authors said.

The woman, in her 40s or 50s, went to an Ebola treatment center in West Africa in January 2015, according to the case report. She told the staff there that for the previous four days, she had experienced fever, fatigue, joint pain and vomiting, and a test at the center confirmed she had Ebola. [10 Deadly Diseases That Hopped Across Species]

There is no specific treatment or vaccine that fights the Ebola virus itself, so health care workers gave the woman the usual care for Ebola patients — intravenous fluids, broad-spectrum antibiotics, multivitamins and pain medication, according to the report, published online Oct. 15 in the journal BMJ Case Reports.

But on her third day in the center, the woman had a major stroke on the left side of her brain. The entire right side of her body became weak. She couldn't move her right arm or leg, or see out of her right eye, and she had problems talking, according to the report.

The stroke surprised doctors, who were treating so many cases of Ebola that they had basically developed Ebola "tunnel vision," said Dr. Paul Dhillon, lead author of the case report and a family medicine doctor with the Canadian Armed Forces. Dhillon was working in Africa as a volunteer with Save the Children UK, a charity that delivers food, water, health care and protection during emergencies.

"You're just like, 'We're treating Ebola, we're treating Ebola,' the occasional malaria and maybe HIV comes in, but it was a bit of a mind change that we had to deal with other stuff, as well," Dhillon told Live Science. "Everyone was so focused on Ebola, the rest of the health care system just kind of shut down."

Fortunately for the patient, the treatment center had a stroke specialist volunteering there for six weeks. But the facility didn't have a CT scanner, meaning the doctors couldn't scan the woman's brain to determine whether she had experienced a hemorrhagic (brain bleed) or ischemic (blood clot) stroke.

An ischemic stroke can be treated with aspirin, but the doctors decided not to do this in this case, because if her stroke was hemorrhagic, it could have worsened her condition. Instead, the doctors just continued giving her supportive care, Dhillon said.

The woman improved over the next few days, regaining the ability to move her right toes and later taking a few steps. Eventually, she tested negative for the Ebola virus on two consecutive tests, which is what is needed for an Ebola patient to be discharged, Dhillon said. [Ebola Vaccines: Here's a Look at the 3 Front-Runners]

Health care workers showed the woman exercises she could do to help rehabilitate from the stroke. They also gave her a mattress, so that she would be less likely to get bedsores in case she didn't have much help at home.

On the 15th day after she was admitted to the hospital, the woman went home, "a survivor of both Ebola and stroke," the authors wrote in the study. "Rehabilitation with good outcomes is possible even in very challenging environments," they added.

One of Dhillon's colleagues saw the woman in the spring, and reported that she was still improving.

Why it matters

In the past, Ebola outbreaks in Africa were relatively small and contained in rural areas. Once these outbreaks ended, foreign health care workers would typically leave the region, said Dr. William Schaffner, an infectious-disease specialist at the Vanderbilt University School of Medicine who was not involved in the new report.

But the 2014 to 2015 West African Ebola outbreak was large, and even now, as the crisis is winding down, health care workers are still flying to Africa to help with the aftermath, Schaffner said. Liberia and Sierra Leone are now Ebola-free, but Guinea continues to have a small number of cases, according to the World Health Organization.

Workers can collect more information about the virus and its complications than they could in previous outbreaks.

"We're getting many more descriptions of individual cases and case series about aspects of Ebola infection which we were either only dimly aware [of] or totally unaware [of] previously," Schaffner told Live Science.

This case report is one example of that, he said. "I actually suspect that this patient's Ebola and her stroke are related," Schaffner said. "The Ebola infection creates a vasculitis — an inflammation of blood vessels — and in the central nervous system, that can result in a stroke."

The case may be the first known published report of stroke happening in an Ebola patient, but it's likely happened in other cases, and reminds doctors that people with Ebola can have other illnesses, too, Schaffner and the authors said.

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