Warning of serious brain disorders in people with
mild coronavirus symptoms
UK neurologists publish details of mildly affected or
recovering Covid-19 patients with serious or potentially fatal brain conditions
Ian Sample
Science editor
@iansample
Published
onWed 8 Jul 2020 08.44 BST
Doctors may
be missing signs of serious and potentially fatal brain disorders triggered by
coronavirus, as they emerge in mildly affected or recovering patients,
scientists have warned.
Neurologists
are on Wednesday publishing details of more than 40 UK Covid-19 patients whose
complications ranged from brain inflammation and delirium to nerve damage and
stroke. In some cases, the neurological problem was the patient’s first and
main 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.
“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.
“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.”
The cases
add to concerns over the long-term health effects of Covid-19, which have left
some patients breathless and fatigued long after they have cleared the virus,
and others with numbness, weakness and memory problems.
One
coronavirus patient described in the paper, a 55-year-old woman with no history
of psychiatric illness, began to behave oddly the day after she was discharged
from hospital.
She
repeatedly put her coat on and took it off again and began to hallucinate,
reporting that she saw monkeys and lions in her house. She was readmitted to
hospital and gradually improved on antipsychotic medication.
Another
woman, aged 47, was admitted to hospital with a headache and numbness in her
right hand a week after a cough and fever came on. She later became drowsy and
unresponsive and required an emergency operation to remove part of her skull to
relieve pressure on her swollen brain.
“We want
clinicians around the world to be alert to these complications of coronavirus,”
Zandi said. He urged physicians, GPs and healthcare workers with patients with
cognitive symptoms, memory problems, fatigue, numbness, or weakness, to discuss
the case with 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.
“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,” Zandi said.
“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.”
David
Strain, a senior clinical lecturer at the University of Exeter Medical School,
said that only a small number of patients appeared to experience serious
neurological complications and that more work was needed to understand their
prevalence.
“This is
very important as we start to prepare post-Covid-19 rehabilitation programs,”
he said. “We’ve already seen that some people with Covid-19 may need a long
rehabilitation period, both physical rehabilitation such as exercise, and brain
rehabilitation. We need to understand more about the impact of this infection
on the brain.”
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