Brain, nervous system affected in 1 in 3 cases of severe Covid-19

A study out of China finds that strokes, altered consciousness and other neurological issues are relatively common in more serious cases of Covid-19.

Looking at 214 cases of severe coronavirus illness treated in Wuhan city during the early phase of the global pandemic, doctors reported that 36.4% of patients displayed neurological symptoms.

Sometimes these symptoms appeared in the relative absence of "typical" symptoms of Covid-19 – fever, cough, diarrhoea – the team said.

In such cases, doctors should consider coronavirus infection as a potential cause of the problem "to avoid delayed diagnosis or misdiagnosis", said a team led by Dr Bo Hu, a neurologist at Union Hospital in Wuhan.

Hu's team published their findings online in JAMA Neurology.

Absence of typical symptoms

The suspicion that the novel coronavirus could infiltrate and affect the brain and central nervous system is not new. Last month, numerous reports emerged that one key sign of infection was a loss of sense of smell, pointing to the virus somehow affecting nerve pathways.

In the new report, Hu's team tracked outcomes for more than 200 people treated at three hospitals in Wuhan, the original epicenter of the Covid-19 pandemic. Patients all had disease severe enough to warrant hospitalisation, and were treated between 16 January and 19 February. They averaged about 53 years of age.

Looking specifically at symptoms affecting the brain or central nervous system, the team found that these issues became more common as the severity of illness rose. And, in some cases, typical Covid-19 symptoms were absent.

"Some patients without typical symptoms … of Covid-19 came to the hospital with only neurological manifestation as their presenting symptoms," the researchers wrote. In some cases, these issues could be life-threatening: there were at least six cases of stroke or brain haemorrhage observed among those studied, Hu's group reported.

Whether or not infection with the coronavirus directly triggered strokes is unclear, the team said, but in severe Covid-19, a "rapid clinical deterioration or worsening could be associated with a neurologic event such as stroke, which would contribute to its high mortality rate."

Other neurological issues were also at play. Many patients arrived at the hospital disoriented or confused, or were dizzy or had headaches or even seizures, the Chinese group said. Impairments in taste or smell were also seen.

More specific neuroimaging needed

Older patients, many of whom had other underlying chronic illnesses, were at highest risk for neurological issues tied to Covid-19, the study found.

Dr Rafael Ortiz is chief of neuro-endovascular surgery at Northwell Health Western Region in New York City and Westchester, New York.

Reading over the new report, he said "these findings could be related to direct involvement of the virus in the brain, brainstem and peripheral nerves." Other symptoms may be due to the stresses put on the body by the illness itself, he added.

The Chinese researchers and Ortiz agreed that this early study may not be the last word on how the new coronavirus affects the brain.

"A prospective, observational study with a larger number of patients that includes more specific neuroimaging and other diagnostic tests is warranted for more conclusive evidence," Ortiz said.

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Image credit: iStock

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