More and more doctors are suggesting coronavirus can affect the brain.
A study of 214 patients in Wuhan, China, the original epicentre of the viral outbreak, concluded the disease “may infect nervous system and skeletal muscle as well as the respiratory tract”.
“In those with severe infection, neurological involvement is greater, which includes acute cerebrovascular diseases, impaired consciousness, and skeletal muscle injury.”
The study found that “of 214 patients with coronavirus disease 2019, neurological symptoms were seen in 36.4 per cent of patients and were more common in patients with severe infection (45.5 per cent).”
It advised clinicians to include COVID-19 as a possible diagnosis if a patient presented with neurological manifestations.
The study was reliant on the subjective patient descriptions of symptoms because of conditions in Wuhan, where imaging was restricted to avoid cross-infection.
However, around the world, other reports of neurological impairment are being reported.
In Detroit, a woman in her late 50s presented to the Henry Ford Health System with “a cough, fever and mental confusion”. Scans revealed swelling in some areas of the brain and areas of brain cell death.
It’s suspected the brain can be damaged by viral infection if a patient’s immune system overreacts to the virus.
One of the woman’s doctors, Henry Ford neurologist Dr Elissa Fory, told The New York Times that the woman’s illness “may indicate the virus can invade the brain directly in rare circumstances”.
That article also described a Florida man who lost the ability to speak after being diagnosed with COVID-19. He was initially sent home after pneumonia was ruled out. When he returned, he appeared to be having a seizure.
“These domestic reports follow similar observations by doctors in Italy, and other parts of the world, of COVID-19 patients having strokes, seizures, encephalitis-like symptoms and blood clots, as well as tingling or numbness in the extremities.
“In some cases, patients were delirious even before developing fever or respiratory illness, according to Dr Alessandro Padovani, whose hospital at the University of Brescia in Italy opened a separate NeuroCovid unit to care for patients with neurological conditions.”
Though most of the reports are anecdotal and the neurological research limited, doctors are being urged to consider whether patients with symptoms of confusion or lethargy may have COVID-19.
Most COVID-19 patients do not exhibit neurological impairment.
“Most people are showing up awake and alert, and neurologically appear to be normal,” said Dr Robert Stevens, a neurologist at the Johns Hopkins School of Medicine in Baltimore.
“It could be as simple as low levels of oxygen in the bloodstream,” resulting from respiratory failure, along with an increase in carbon dioxide, which “can have significant impact on the function of the brain, and lead to states of confusion and lethargy,” he said.
Dr Sherry H-Y Chou, a neurologist at the University of Pittsburgh School of Medicine, is leading a team of investigators for the Neurocritical Care Society.
“There’s no ventilator for the brain,” she told The New York Times. “If the lungs are broken, we can put the patient on a ventilator and hope for recovery. We don’t have that luxury with the brain.”
Are you carefully following COVID-19 developments? Are you also careful to switch off?
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