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COVID-19 Neurological Complications Could Cause Long Term Brain Damage in Recovered Patients, Warn Researchers

By HospiMedica International staff writers
Posted on 14 Jul 2020
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Image: Brain scan images from the study (Photo courtesy of University College London)
Image: Brain scan images from the study (Photo courtesy of University College London)
Researchers have warned that COVID-19 neurological complications, including delirium, brain inflammation, stroke, and nerve damage, could result in large scale brain damage in recovered patients over the long term.

In a new study by the University College London (London, UK), the research team identified one rare and sometimes fatal inflammatory condition, known as acute disseminated encephalomyelitis (ADEM), which appears to be increasing in prevalence due to the pandemic. Some patients in the study did not experience severe respiratory symptoms, and the neurological disorder was the first and main presentation of COVID-19.

The study provides a detailed account of neurological symptoms of 43 people who had either confirmed or suspected COVID-19. The researchers identified 10 cases of transient encephalopathies (temporary brain dysfunction) with delirium, which corresponds with other studies finding evidence of delirium with agitation. There were also 12 cases of brain inflammation, eight cases of strokes, and eight others with nerve damage, mainly Guillain-Barré syndrome (which usually occurs after a respiratory or gastrointestinal infection). Most (nine out of 12 cases) of those with brain inflammation conditions were diagnosed with ADEM, which is rare and typically seen in children and can be triggered by viral infections. The researchers normally see about one adult patient with ADEM per month, but that increased to at least one per week during the study period, which they said was a concerning increase.

SARS-CoV-2 was not detected in the cerebrospinal brain fluid of any of the patients tested, suggesting the virus did not directly attack the brain to cause the neurological illness. Further research is needed to identify why patients were developing these complications. In some patients, the researchers found evidence that the brain inflammation was likely caused by an immune response to the disease, suggesting that some neurological complications of COVID-19 might come from the immune response rather than the virus itself. The findings add clinical descriptions and detail to another recent study identifying 153 people with neurological complications from COVID-19. The latest study also confirmed the previously reported findings of a higher than expected number of patients with stroke resulting from excessive stickiness of blood in COVID-19 patients.

“We identified a higher than expected number of people with neurological conditions such as brain inflammation, which did not always correlate with the severity of respiratory symptoms,” said joint senior author Dr. Michael Zandi (UCL Queen Square Institute of Neurology and University College London Hospitals NHS Foundation Trust). “We should be vigilant and look out for these complications in people who have had COVID-19. Whether we will see an epidemic on a large scale of brain damage linked to the pandemic, perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic, remains to be seen.”

“Given that the disease has only been around for a matter of months, we might not yet know what long-term damage COVID-19 can cause,” said joint first author Dr. Ross Paterson from the UCL Queen Square Institute of Neurology. “Doctors need to be aware of possible neurological effects, as early diagnosis can improve patient outcomes. People recovering from the virus should seek professional health advice if they experience neurological symptoms.”

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