Neurologists around the world stated that a small subset of patients with COVID-19 is developing serious impairments of the brain.
Despite the fact that fever, cough and difficulty breathing are the typical hallmarks of infection with the coronavirus, few patients changed mental status, or encephalopathy, a catchall term for brain disease or dysfunction that can have numerous hidden causes, as well as other serious conditions. These neurological disorders join other unordinary indications, such as a diminished sense of smell and taste as well as heart ailments.
One case patient who do not have pneumonia based on X-ray results connote that the person may not have coronavirus despie having cough and fever. Hence, the patient was sent home. The following day, the person's fever spiked, and the relatives brought the patient back. Physicians diagnosed a dangerous condition called acute necrotizing encephalopathy, a rare complication of flu and other viral diseases.
This condition may result to seizures that require immediate medical care, and experts are warning health care providers who treat such patients to recognize that they may have COVID-19 and to take precautions to protect themselves from the coronavirus. Much is still unknown about the neurological side effects. However, efforts are in progress to study the phenomena, said Dr. Chou, a neurologist at the University of Pittsburgh School of Medicine, who is leading a team of investigators for the Neurocritical Care Society.
Coronavirus may affect the brain
"We absolutely need to have an information finding mission, otherwise we're flying blind, there's no ventilator for the brain. If the lungs are broken we can put the patient on a ventilator and hope for recovery," Chou said.
Robert Stevens, a neurologist at the Johns Hopkins School of Medicine in Baltimore said that most people are showing up awake and alert, and neurologically appear to be normal. Experts have emphasized that most COVID-19 patients appear to be normal neurologically.
Neurological experts also say that it is too soon to make conclusive statements or distinguish the specific mechanisms by which the new coronavirus is affecting the neurological system.
Chinese scientists noted that there was some proof that other coronaviruses were not limited to the respiratory tract and invaded the central nervous system, and the authors speculated that this may potentially play a role in acute respiratory failure in COVID-19.
Neurologists in Wuhan, China, where the outbreak started, were among the first to report the symptoms in a preliminary paper published online in February. Since that report, specialists observed similar symptoms in Germany, France, Austria, Italy, and Holland as well as the United States, including among patients under 60, Dr. Paul Nee, an infectious disease specialist at the hospital.
Nee said, "the striking thing is we have not seen any real respiratory illness in these patients," while it is not unusual for elderly people to encounter confusion when they develop other infections. They have kept on testing positive and cannot be discharged, despite the fact that they are not really sick, he said.
But earlier reports had indicated that seriously sick people with more typical symptoms were more likely to exhibit the rare neurological conditions, which went from dizziness and headaches to impaired consciousness, stroke and musculoskeletal injury. The Chinese study in February said that about 15 percent of those patients with severe sickness encountered a change in mental status, compared with 2.4 percent of the individuals who didn't have a serious disease, according to that study.
Another study, published in the British Medical Journal in late March, found that of 113 patients from Wuhan who died of COVID-19, 22 percent had encountered disorders of consciousness, ranging from drowsiness to deep coma, compared with only 1 percent of another group of patients who recovered from the illness. For potential COVID-19 patients and the people caring for them, the Centers for Disease Control and Prevention includes new confusion or inability to rouse among the warning signs that should prompt a decision to seek immediate medical care.
Patients who have encephalopathy and seem confused or incoherent are prone to having seizures, and should receive treatment as soon as possible, said Dr. Jennifer Frontera, a neurologist at N. Langone Health who is working with Dr. Chou. She added that seizures can manifest in more subtle ways than the dramatic presentations often depicted in movies and television shows.
Dr. Frontera said that seizures are not always big things where people fall down and are shaking on the ground, some could be just veering off, not paying attention, making repetitive non-purposeful movements, or just mental status changes, where people are just not themselves. But even if seizures are not observed, people who are sick should be aware of other potential mental symptoms.
Frontera said, "you don't feel your best when you have a fever, but you should be able to interact normally, you should be able to answer questions and converse in a normal fashion, I don't want everyone calling 911 because they're overly concerned. We just don't have the capacity. But if someone is really out of it, they probably need medical attention."
