BREAKING! COVID-19 Neurology: Study Says More Neurological Complications Arising In COVID-19 Including ADEM (Acute Disseminated Encephalomyelitis)
Source: COVID-19 Neurology Jul 08, 2020 4 years, 4 months, 2 weeks, 22 hours, 50 minutes ago
COVID-19 Neurology: A new study by University College London (UCL) and University College London Hospitals (UCLH) indicate that more neurological conditions are being manifested in COVID-19 patients. Besides delirium, brain inflammation, stroke and nerve damage, a large number of patients are now shown to be inflicted with ADEM or Acute Disseminated Encephalomyelitis and its prevalence is growing as a result of the COVID-19 pandemic.
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Acute Disseminated Encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of the central nervous system. ADEM is thought to be an autoimmune disorder in which the body's immune system mistakenly attacks its own brain tissue, triggered by an environmental stimulus in genetically susceptible individuals.
The research findings were published in the journal: Brain.
https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408
Interestingly, some patients in the study did not experience severe respiratory symptoms, and the neurological disorder was the first and main presentation of Covid-19.
Dr Michael Zandi, (UCL Queen Square Institute of Neurology and University College London Hospitals NHS Foundation Trust) joint senior author told Thailand Medical News, "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. We should be vigilant and look out for these complications in individuals 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."
The new research provides a detailed account of neurological symptoms of 43 people (aged 16-85) treated at the National Hospital for Neurology and Neurosurgery, UCLH, who had either confirmed or suspected Covid-19.
The study team 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).
Majority (nine out of 12 cases) of those with brain inflammation conditions were diagnosed with acute disseminated encephalomyelitis (ADEM). ADEM is rare and typically seen in children and can be triggered by viral infections: the team in London normally sees about one adult patient with ADEM per month, but that increased to at least one per week during the study period, which the researchers say is a concerning increase.
The SARS-CoV-2 coronavirus virus causing Covid-19 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 certain 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 study findings add clinical descriptions and detail to another recent study, which also involved Dr Zandi and co-author Dr Hadi Manji (UCL Queen Square Institute of Neurology) identifying 153 people with neurological complications from Covid-19. This paper also confirms the previously reported findings of a higher than expected number of patients with stroke which results from the excessive stickiness of the blood in COVID-19 patients.
Dr Ross Paterson (UCL Queen Square Institute of Neurology) co-author added, "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. 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.”
Dr Rachel Brown, (UCL Queen Square Institute of Neurology and UCL Infection & Immunity) joint first author said, "Our study advances understanding of the different ways in which Covid-19 can affect the brain, which will be paramount in the collective effort to support and manage patients in their treatment and recovery."
Dr Hadi Manji , joint senior author further added, "Our study amalgamates, for the first time, the clinical presentations of patients with Covid-19 neurological disease with MRI and laboratory features including, in one case, a brain biopsy. This now sets up a template for other researchers around the world, facilitating coordinated research to optimize the diagnosis and treatments of these complications, which to date, have proved difficult. In addition, patients are going to require long term follow up."
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