As COVID-19 has swept the world, the focus has been on keeping patients alive. Now, physicians are examining the impact the disease can have on the survivors’ bodies and long-term health.
Neurologist Majid Fotuhi, MD, PhD, medical director of Tysons Corner, Va,-based NeuroGrowBrain Fitness Center and affiliate staff at Johns Hopkins Medicine, is warning about neurological issues in patients who suffer from COVID-19, and he encourages more study of the neurological effects of the disease to promote better treatments.
“We now know that COVID patients can have varying levels of neurological symptoms. As a medical community, we have for now justifiably focused on the immediacy of saving their lives,” says Fotuhi. “However, as time goes on, we will need to better assess, document, and treat the neurological manifestations of this disease and keep in mind that patients who survive COVID-19 may have long-term brain deficits. The better we understand the brain-related aspects of COVID-19, the better we can address them and help patients have productive, fulfilling lives.”
The urgency of caring for COVID-19 patients in recent week coupled with the difficulty in evaluating patients that are contagious has made it more complicated to determine the extent of neurological issues associated with the disease. Despite these limitations, a dozen case reports and anecdotal findings are painting a sketch of what may be going on inside the brains of patients with COVID-19.
Fotuhi recently wrote a blog and co-authored a paper that will be published in the Journal of Alzheimer’s Disease on the topic of COVID-19’s effects on the brain, nerves, and muscles. He points out that many COVID-19 patients experience severe neurological problems such as stroke, seizures, confusion, dizziness, paralysis, and/or coma. One study from Wuhan, China, showed that 45% of patients with severe COVID-19 illness experience marked neurological deficits. Another study from France showed 84% of ICU patients with COVID-19 have positive abnormalities on their neurological examination.
Fotuhi groups COVID-19’s neurological manifestation into three stages. In NeuroCovid Stage I, the virus damage is limited to epithelial cells of nose and mouth. In NeuroCovid Stage II, patients may experience blood clots in their brain or have auto-antibodies that damage their peripheral nerves and muscles. In this stage, the virus can trigger a flood of inflammatory markers, called cytokine storm, which begin in the lungs and travel throughout all body organs. This may lead to blood clots resulting in a series of strokes that can kill neurons. In NeuroCovid Stage III, the blood brain barrier, a protective insulation in blood vessels of the brain, is damaged and patients may develop seizures or encephalopathy. In this rare late stage, the virus particles themselves may invade the brain directly, including the brain region that controls breathing.
He points out that many patients with COVID-19 may have no noticeable neurological symptoms at first; but in some cases, patients may present with neurological symptoms even before they have fever, cough, or shortness of breath. He stresses that having an MRI while at the hospital will be an important tool in developing an optimal treatment strategy for these patients. In addition, patients will need to be monitored in a few months after their hospitalization as they may have new symptoms not experienced early in their disease process.
“Our experience with other forms of respiratory viruses that affect the brain suggest that in the long-term patients may develop depression, insomnia, Parkinson’s disease, memory loss, or accelerated aging in the brain,” says Fotuhi.
