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Liverpool – Smell and taste disorders are not the only neurological symptoms of COVID-19. A survey among British doctors in Lancet Psychiatry (2020: DOI: 1010.1016 / S2215-0366 (20) 30287-X) showed that the new coronavirus SARS-CoV-2 can also attack the brain. In addition to cerebrovascular complications such as a stroke, psychiatric symptoms such as psychosis have also been observed.
The fact that coronaviruses can infect the brain has already been observed in the first SARS epidemic and also in patients with the “Middle East Respiratory Syndrome” (MERS). According to a recently published meta-analysis, confusion, depressive moods, anxiety, memory disorders and insomnia often occur in the acute phase of SARS and MERS. In addition, steroid-induced mania and psychosis can occur. Many symptoms persist in the recovery phase and some patients suffer from post-traumatic stress disorder in the long term (Lancet Psychiatry 2020; 7: 611-627).
Soon after the start of the SARS-CoV-2 epidemic in China, there were reports of severe neuropsychiatric symptoms and meningoencephalitis. This has prompted several British professional societies to collect information on the neurological and psychiatric complications at an early stage.
In the CoroNerve.com platform, doctors were able to provide data on conspicuous patients. 153 cases were reported in the exponential phase of the epidemic from April 2 to 26. All patients met the clinical case definition of a COVID-19.
According to the team led by Benedict Michael from Liverpool University, the patients were between 23 and 94 years old. Of the 125 patients for whom complete clinical data sets were available, 77 (62%) had a cerebrovascular event.
These included 57 patients (74%) with an ischemic stroke, 9 patients (12%) with intracerebral bleeding and 1 patient (1%) with vasculitis.
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Psychiatric changes were documented in 39 of the 125 patients (31%). Among them were 9 patients (23%) with unspecified encephalopathy and seven patients (18%) with signs of encephalitis.
Changes in mental state that met the criteria for psychiatric diagnosis were observed in the remaining 23 patients (59%). Among them were 10 patients with a new onset psychosis, 6 patients with neurocognitive (dementia-like) disorders and 4 patients with an affective disorder.
49% of the patients with neuropsychiatric disorders were younger than 60 years old, while 82% of the cerebrovascular events occurred in patients older than 60 years.
As these are spontaneous reports, the study cannot make any statements about the frequency of the disorders. However, during the current COVID-19 pandemic, Michael advises doctors to consider the possibility of infection with SARS-CoV-2 in patients with acute neurological and / or psychiatric symptoms. © rme / aerzteblatt.de
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