People With Mild COVID19 May

Experience Serious Brain Disorders:

UK Neurologists 8Jul20

by Tyler Durden
Wed, 07/08/2020 - 12:35

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COVID-19 is quite the enigma. For most patients who contract it - especially those
under the age of 65, symptoms are mild or non-existent. For symptomatic patients
who draw the short straw, the disease can be brutal. Symptoms can include lung
issues, heart damage, loss of taste and smell, tingling in fingers and toes, skin
disorders, and the fact that it lasts for months in some cases.

Now, we find that a small number of recovering COVID-19 patients with mild cases
may suffer 'mild to potentially fatal brain disorders' triggered by the virus,
according to a new manuscript by neurologists from the UK.

On Wednesday, they published the details of more than 40 patients whose

complications ranged "from brain inflammation and delirium to nerve damage
and stroke." The neurological issues were some patients' first and primary
symptom. 

The cases, published in the journal Brain, revealed a rise in a life-threatening

condition called acute disseminated encephalomyelitis (Adem), as the first wave of
infections swept through Britain. At UCL’s Institute of Neurology, Adem cases rose
from one a month before the pandemic to two or three per week in April and May.
One woman, who was 59, died of the complication.

A dozen patients had inflammation of the central nervous system, 10 had brain
disease with delirium or psychosis, eight had strokes and a further eight had
peripheral nerve problems, mostly diagnosed as Guillain-Barré syndrome, an
immune reaction that attacks the nerves and causes paralysis. It is fatal in 5% of
cases. -The Guardian

"We’re seeing things in the way Covid-19 affects the brain that we haven’t seen
before with other viruses," said Michael Zandi, a senior author on the study and a
consultant at the institute and University College London Hospitals NHS foundation
trust (via The Guardian).

"What we’ve seen with some of these Adem patients, and in other patients, is you can
have severe neurology, you can be quite sick, but actually have trivial lung disease,"
he added.

"Biologically, Adem has some similarities with multiple sclerosis, but it is more
severe and usually happens as a one-off. Some patients are left with long-term
disability, others can make a good recovery."

One coronavirus patient, a 55-year-old woman with no prior history of mental

disorders, began hallucinating the day after she was discharged from the hospital -
claiming she saw monkeys and lions in her house. She would also repeatedly remove
and put on her coat. The woman was readmitted and gradually improved with the use
of antipsychotic medication. 

A 47-year-old woman included in the paper reported a headache and numbness in

her right hand one week after she began experiencing a cough and a headache. She
became drowsy and unresponsive, and required the surgical removal of a portion
of her skull to relieve pressure on her swollen brain, according to The Guardian.

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"We want clinicians around the world to be alert to these complications of

coronavirus," said Zandi, who urged healthcare providers to report cognitive
symptoms to neurologists.
"The message is not to put that all down to the recovery, and the psychological
aspects of recovery," he said. "The brain does appear to be involved in this illness."

The full range of brain disorders caused by Covid-19 may not have been picked up
yet, because many patients in hospitals are too sick to examine in brain scanners or
with other procedures. “What we really need now is better research to look at
what’s really going on in the brain,” Zandi said.

One concern is that the virus could leave a minority of the population with subtle
brain damage that only becomes apparent in years to come. This may have happened
in the wake of the 1918 flu pandemic, when up to a million people appeared to
develop brain disease. -The Guardian

"It’s a concern if some hidden epidemic could occur after Covid where you’re going
to see delayed effects on the brain, because there could be subtle effects on the brain
and slowly things happen over the coming years, but it’s far too early for us to judge
now," said Zandi. "We hope, obviously, that that’s not going to happen, but when
you’ve got such a big pandemic affecting such a vast proportion of the population it’s
something we need to be alert to."

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See PDF

The emerging spectrum of COVID-19

neurology: clinical, radiological and
laboratory findings
Ross W Paterson, Rachel L Brown, Laura Benjamin, Ross Nortley, Sarah Wiethoff,
Tehmina Bharucha, Dipa L Jayaseelan, Guru Kumar, Rhian E Raftopoulos, Laura
Zambreanu,
Vinojini Vivekanandam, Anthony Khoo, Ruth Geraldes, Krishna Chinthapalli, Elena
Boyd, Hatice Tuzlali, Gary Price, Gerry Christofi, Jasper Morrow, Patricia
McNamara, Benjamin McLoughlin, Soon Tjin Lim, Puja R Mehta, Viva Levee,
Stephen Keddie, Wisdom Yong, S Anand Trip, Alexander J M Foulkes, Gary Hotton,
Thomas D Miller, Alex D Everitt, Christopher Carswell, Nicholas W S Davies,
Michael Yoong, David Attwell, Jemeen Sreedharan, Eli Silber, Jonathan M Schott,
Arvind Chandratheva, Richard J Perry, Robert Simister, Anna Checkley, Nicky
Longley, Simon F Farmer, Francesco Carletti, Catherine Houlihan, Maria Thom,
Michael P Lunn, Jennifer Spillane, Robin Howard, Angela Vincent, David J Werring,
Chandrashekar Hoskote, Hans Rolf Jäger, Hadi Manji, Michael S Zandi, the UCL
Queen Square National Hospital for Neurology and Neurosurgery COVID-19 Study
Group
Author Notes
Brain, awaa240, https://doi.org/10.1093/brain/awaa240
Published:
08 July 2020
Article history

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Abstract
Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric
illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19)
neurology multi-disciplinary meeting was established at the National Hospital, Queen
Square, in early March 2020 in order to discuss and begin to understand neurological
presentations in patients with suspected COVID-19-related neurological disorders.
Detailed clinical and paraclinical data were collected from cases where the diagnosis
of COVID-19 was confirmed through RNA PCR, or where the diagnosis was
probable/possible according to World Health Organization criteria. Of 43 patients, 29
were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five
major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and
no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery
with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including
encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n
= 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated
myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these
patients also received intravenous immunoglobulin; one made a full recovery, 10 of
12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8)
associated with a pro-thrombotic state (four with pulmonary thromboembolism), one
of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-
Barré syndrome, one with brachial plexopathy, six of eight making a partial and
ongoing recovery; and (v) five patients with miscellaneous central disorders who did
not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of
neurological syndromes affecting the whole neuraxis, including the cerebral
vasculature and, in some cases, responding to immunotherapies. The high incidence
of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is
striking. This complication was not related to the severity of the respiratory COVID-
19 disease. Early recognition, investigation and management of COVID-19-related
neurological disease is challenging. Further clinical, neuroradiological, biomarker and
neuropathological studies are essential to determine the underlying pathobiological
mechanisms, which will guide treatment. Longitudinal follow-up studies will be
necessary to ascertain the long-term neurological and neuropsychological
consequences of this pandemic.
COVID-19, SARS-CoV-2, encephalitis, ADEM
Topic:
 polymerase chain reaction
 encephalomyelitis, acute disseminated
 encephalitis
 nervous system disorders
 myelitis
 neurology
 infections
 diagnosis
 laboratory test finding
 sars-cov-2
 covid-19

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