Neurological Complications of COVID-19
According to a new UCL and UCLH-led study, neurological complications of Covid-19 can include nerve damage, stroke, brain inflammation, and delirium.
ADEM (Acute disseminated encephalomyelitis) is one rare and sometimes fatal inflammatory condition, which was identified to be increasing in prevalence due to the pandemic by the research team in their study published in the journal Brain.
In the study, some patients experienced neurological disorder as the first and main presentation of Covid-19 and did not experience severe respiratory symptoms.
Dr. Michael Zandi, Joint senior author (UCL Queen Square Institute of Neurology and University College London Hospitals NHS Foundation Trust) said, “A higher number of people than expected, having neurological conditions such as brain inflammation were identified.”
Around 43 people’s (aged 16-85) detailed account of neurological symptoms who had either confirmed or suspected Covid-19 treated at the National Hospital for Neurology and Neurosurgery, UCLH, is provided in the study.
10 cases of transient encephalopathies (temporary brain dysfunction) with delirium, corresponding with other studies finding evidence of delirium with agitation were identified by the researchers. There were also eight cases with nerve damage, mainly Guillain-Barré syndrome (which usually occurs after a respiratory or gastrointestinal infection), eight cases of strokes, and 12 cases of brain inflammation.
Acute disseminated encephalomyelitis (ADEM) was diagnosed in most (nine out of 12 cases) of those with brain inflammation conditions. ADEM can be triggered by viral infections and is rare and typically seen in children. One adult patient with ADEM per month is normally observed by the team in London, however, during the study period, that increased to at least one per week, which is a concerning increase according to the researchers.
The study suggests that the virus did not directly attack the brain to cause the neurological illness as the SARS-CoV-2 virus causing Covid-19, was not detected in the cerebrospinal brain fluid of any of the patients tested. To identify why patients were developing these complications, further research is needed.
The study also suggested that some neurological complications of Covid-19 might come from the immune response rather than the virus itself as the researchers found evidence in some patients that the brain inflammation was likely caused by an immune response to the disease.
Around 153 people with neurological complications from Covid-19 were identified in another study, which also involved Dr. Zandi and co-author Dr. Hadi Manji (UCL Queen Square Institute of Neurology), and the findings from the UCLH-led study add clinical descriptions and detail to the other recent study. The previously reported findings of excessive stickiness of the blood in COVID-19 patients causing a stroke is higher than the expected number of patients is also confirmed in this paper.
Dr. Ross Paterson from UCL Queen Square Institute of Neurology, the joint first author
said, “We might not yet know what long-term damage Covid-19 can cause given that the disease has only been around for a matter of months.”
He added, “Early diagnosis can improve patient outcomes, and thus doctors need to be aware of possible neurological effects. Professional health advice must be taken if people recovering from the virus experience neurological symptoms.”
Dr. Rachel Brown from UCL Queen Square Institute of Neurology and UCL Infection & Immunity, the joint first author said, “In the collective effort to support and manage patients in their treatment and recovery, understanding the different ways in which Covid-19 can affect the brain will be paramount, and our study advances this understanding.”
Dr. Hadi Manji, Joint senior author said, “Our study amalgamates the clinical presentations of patients with Covid-19 neurological disease with MRI and laboratory features including, in one case, a brain biopsy, for the first time.”
“In order to optimize the diagnosis and treatments of these complications, this now sets up a template for other researchers around the world, facilitating coordinated research.”
Author: Prathibha
