COVID-19 associated with (sometimes serious) neurological problems

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It remains unclear how often the neurological complications occur and what long-term consequences they have.

Where SARS-CoV-2 was initially primarily seen as a virus that had targeted the respiratory system, more and more studies show that the virus can (indirectly) cause major problems in almost every part of the body. And the brain is also not immune to the far-reaching influence of the virus, a new study published in the magazine found Brain.

Delirium, stroke and encephalitis
In the magazine, the researchers describe 43 corona patients (aged between 16 and 85 years) who were admitted to a London hospital in recent months and who sometimes developed severe neurological symptoms. Patients experienced delirium (acute confusion), strokes and nerve damage (often involving Guillain-Barré Syndrome, which affects the motor nerves and sensory nerves).

Some patients also developed brain inflammation. A large proportion of these patients have been diagnosed with what doctors call acute disseminated encephalomyelitis (ADEM for short). This is a normally quite rare condition that usually affects children and is triggered by a viral infection. Normally, only one adult with this brain disease is admitted to the London hospital every month. However, during the period that this study was ongoing, an adult patient with ADEM was admitted every week. And that is worrying, the researchers say.

Neurological problems as the only symptom
“We identified a larger than expected number of people with neurological problems, such as encephalitis,” concluded researcher Michael Zandi. What is also striking is that these neurological problems did not always go hand in hand with serious breathing problems. In fact, in some corona patients, neurological problems were the first and only symptom of COVID-19.

Watchful
It is a good reason to investigate whether there may be a connection with SARS-CoV-2 in the case of neurological problems. “We must be vigilant and watch for these complications in people who have had COVID-19,” Zandi emphasizes. “Doctors should be aware of potential neurological effects,” added colleague Ross Paterson. “Because an early diagnosis can lead to better outcomes. In addition, people who are currently recovering from the virus should see a doctor if they experience neurological symptoms. ”

Cause
It is unclear at this stage how exactly the virus can lead to the neurological problems described above. The researchers were unable to find the virus in the cerebrospinal fluid in any of the patients. It suggests that the virus does not directly attack the brain. In addition, in some patients, evidence was found that it is not the virus itself, but their immune response to the virus that underlies the neurological problems. More research into the exact facts of the problems is therefore urgently needed.

Magnitude of the problem
What also remains unclear is what proportion of corona patients develop these symptoms and what long-term consequences the symptoms may have. “Whether we will see a large-scale epidemic of brain damage related to this pandemic (…) remains to be seen,” Zandi emphasizes. Professor Anthony David – indirectly involved in the study – doesn’t expect it to come to that. “While in the UK we actually have only five months of real experience with COVID-19, 11 million cases have already been reported in the rest of the world, and it’s the high income countries that – with their vast array of options when it comes – about making diagnoses – until recently the hardest hit. ” The fact that relatively few patients with severe neurological problems have been reported therefore suggests that the neurological complications are relatively rare. “It is unlikely that there will be a parallel pandemic characterized by unusual brain damage and related to COVID-19.”

For now, the research should mainly be seen as a cross. “It portrays an area that now needs to be explored rigorously and systematically,” said David. The researchers see it the same way. “(The study, ed.) Creates a blueprint for follow-up research, aimed at better diagnosis and treatment of these complications,” said researcher Hadi Manji. “In addition, it is important that patients are followed for a long time.”

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