NeuroCOVID: Study Shows That Even Moderate COVID-19 Cases Experience Long-Term Neurological Complications And Harm

NeuroCOVID: A new study by researchers from Boston University Medical Center and Boston University School of Medicine shows that SARS-CoV-2 infections can cause a wide range of neurological complications, even in patients who are not critically ill.


 
The study was conducted to characterize the breadth of neurologic findings associated with SARS-CoV-2 infection in a diverse group of inpatients at an urban, safety-net US medical center.
 
Patients were identified through an electronic medical record review from April 15, 2020, until July 1, 2020, at a large safety-net hospital in Boston, MA, caring primarily for underserved, low-income, and elderly patients. All hospitalized adult patients with positive nasopharyngeal swab or respiratory PCR testing for SARS-CoV-2 during their hospitalization or in the 30 days prior to admission who received an inpatient neurologic or neurocritical care consultation or admission during the study period were enrolled.
 
A total of seventy-four patients were identified (42/57% male, median age 64 years). The majority of patients self-identified as Black or African-American (38, 51%).
 
The most common neurologic symptoms at presentation to the hospital included altered mental status (39, 53%), fatigue (18, 24%), and headache (18, 18%). Fifteen patients had ischemic strokes (20%). There were 10 in-hospital mortalities, with moderately severe disability among survivors at discharge (14%, median modified Rankin Scale score of 4).
 
Neurologic findings spanned inflammatory, vascular pathologies, sequelae of critical illness and metabolic derangements, possible direct involvement of the nervous system by SARS-CoV-2, and exacerbation of underlying neurologic conditions, highlighting a broad range of possible etiologies of neurologic complications in patients with coronavirus disease 2019 (COVID-19).
 
The study findings were published in the peer reviewed journal: Neurology Clinical Practice ( A journal of the American Academy Of Neurology). https://cp.neurology.org/content/early/2020/12/03/CPJ.0000000000001031
 
From the beginning of the COVID-19 pandemic, it was clear that infection with SARS-CoV-2 can affect organ systems throughout the body. That includes problems affecting the brain and nervous system, ranging from altered mental states to seizures to strokes.
 
The study team found that among COVID patients at their safety-net hospital, neurological complications ran the gamut. And they were even seen in people who were more moderately ill with the infection.
 
Typically safety-net hospitals are obligated, by mandate or mission, to treat individuals regardless of their ability to pay. So they typically have a large share of patients who are low-income, minority and either uninsured or on Medicaid. Most of those Americans have also been among the hardest-hit by the COVID pandemic.
 
However it is still unclear at this point whether Black or Hispanic Americans are at increased risk of neurologic complications, according to lead researcher Dr Pria Anand, from Boston Medical Center.
 
Dr Anand told Thailand Medical News that it is important t o document how the complications are showing up in hospitals serving low-income and minority patients.
 
She and her colleagues studied the records of more than 900 COVID patients treated at their hospital between April 15 and July 1. Of that group, 74 needed a neurological consult or admission.
 
It was found that 18 patients suffered a stroke, 15 had seizures, and 26 were diagnosed with encephalopathy-a broad term for brain dysfunction, including confusion and delirium.
 
Many other patients developed nerve damage or movement problems. They included five with myoclonus, where muscles twitch or jerk involuntarily.
 
Interestingly one patient showed signs of autoimmune encephalitis, a rare condition where the immune system attacks tissue in the spinal cord or brain, causing inflammation. The patient improved after treatment with anti-inflammatory corticosteroids.
 
Typically, neurological complications of COVID seem to fall into a few different "buckets," said Dr Anand, who is also an assistant professor at Boston University School of Medicine.
 
Also certain problems, she said, are related to an overactive immune response such as Guillain-Barre syndrome, where the immune system attacks the body's nerves.
 
However in other cases, Dr Anand said, complications arise simply because a patient is critically ill in the hospital, and sometimes on a ventilator.
 
Furthermore, COVID-19 does affect the vascular system in some patients, making the blood more prone to clotting, for example. And that can be behind complications like stroke.
 
Importantly Dr Anand said, it's possible the virus itself invades the central nervous system in some patients. That's sometimes seen with certain other viruses, she noted such as herpes and cytomegalovirus.
 
Dr Aaron Glatt, a spokesperson for the Infectious Diseases Society of America commented that at this point, doctors have learned more about managing COVID, in ways that can help prevent neurologic complications,
 
This includes using medications like corticosteroids and drugs to prevent blood clots.
 
Dr Glatt pointed out that the patients in this study were a select group ie those sick enough to require a neurological consult in the hospital. And of the 74 patients, 47 had a history of neurological conditions.
 
Dr Glatt, who wasn't part of the study said, "This isn't looking at all comers."
 
Having said that, he also stressed that even individuals with milder COVID, who never entered the hospital, can have lasting neurologic symptoms.
 
Physicians worldwide have been reporting seeing patients with lingering fatigue and what's been dubbed "brain fog" ie problems with memory, concentration and other mental skills.
 
He added, "There's a false sense of security among younger people, that COVID is only a risk to older people who end up in the hospital. I've taken care of many patients in their 30s and 40s and they were very sick."
 
Dr Anand agreed that individuals should be aware that death is not the only bad outcome of COVID, and people can face difficult recoveries.
 
It must be also noted that in her study group, 10 patients died in the hospital. And while most left the hospital, the majority were released to skilled nursing facilities or other care to continue their recovery.
 
Dr Anand warned "Even after you leave the hospital, there can be a long road ahead."
 
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