Healthcare Research

COVID-19 and the brain

We have been looking at how Corona Virus or Covid19 impacts the brain and cognition. Both short term and more severe long term neurological changes have been noticed from confusion to loss of smell and taste to life-threatening strokes.  Some people in their 30s and 40s are suffering possibly life-changing neurological issues due to strokes. 

More than 300 studies from around the world have found a prevalence of neurological abnormalities in Covid-19 patients. Corona virus being a new condition researchers don’t yet have the answers as to why the brain might be harmed by this disease but they do have their theories.

“We don’t know yet if the encephalopathy is more severe with Covid-19 than with other viruses, but I can tell you we’ve been seeing quite a lot of it,” says neurologist Elissa Fory of the Henry Ford Foundation in Detroit, Michigan. “As the number of cases increases, you will start to see not only the common manifestations but also the uncommon manifestations – and we’re seeing them all at once, which is not something any of us have encountered in our lifetimes.”

What are neuro conditions are being seen in Covid -19 patients?

  • Confusion
  • Loss of consciousness
  • Seizures
  • Stroke
  • Loss of smell and taste
  • Headaches
  • Trouble focusing
  • Changes in behavior

Patients are also having peripheral nerve issues, such as Guillain-Barré syndrome, which can lead to paralysis and respiratory failure. Critical care physician and neurointensivist Robert Stevens, M.D., who is the associate director of the Johns Hopkins Precision Medicine Center of Excellence for Neurocritical Care, has been tracking cases at Johns Hopkins in which patients with COVID-19 also have neurological problems estimates that at least half of the patients he sees in the COVID-19 units have neurological symptoms which is certainly something worthy of further investigation.

Why does COVID-19 affect the brain?

Based on the current research, researchers believe there are four ways COVID-19 may harm the brain, but each needs to be studied rigorously before any conclusions can be made.

Severe Infection

The first possible way is that the virus may have the capacity to enter the brain and cause a severe and sudden infection.

Immune System in Overdrive

A second possibility is that the immune system goes into overdrive in an attempt to fight COVID-19, producing a “maladaptive” inflammatory response that may cause much of the tissue and organ damage seen in this disease — perhaps more than the virus itself.

Chaos in the Body

The third theory is that all of the physiological changes induced in the body by COVID-19 — ranging from high fevers to low oxygen levels to multiple organ failures — contribute to, or account for, brain dysfunction, such as the delirium or coma seen in many of the severe COVID-19 patients.

Blood-Clotting Abnormalities

The fourth way COVID-19 might affect the brain has to do with the tendency for these patients to suffer a stroke. The blood-clotting system in patients with the illness is highly abnormal, with clots much more likely to occur in these patients than in others. Clots can form in veins deep inside the body or in the lungs, where they can cut off blood flow. A stroke could occur if a blood clot were to block or narrow arteries leading to the brain.

How have past viruses impacted the brain?

One of the most notorious virus was the influenza virus responsible for the 1918 pandemic, which caused permanent and profound damage to the dopamine neurons of the brain and central nervous system. (While it’s long been assumed that influenza cannot cross the blood-brain barrier, some scientists now think that it can). An estimated five million people worldwide were hobbled by a form of extreme exhaustion known as “sleepy sickness” or “encephalitis lethargica”.

David Nutt, professor of neuropsychopharmacology at Imperial College London, says he himself treated many patients in the 1970s and 1980s who had suffered from severe clinical depression ever since the 1957 influenza pandemic in the UK he warns that we could see the very same thing happen again, but on a much larger scale. “People who are discharged from the ICU with Covid-19 need to be monitored systematically long-term for any evidence of neurological damage – and then given interventionist treatments if necessary.”

Who is studying impacts on the brain associated with COVID-19?

John Hopkins are investigating selected cases by conducting the appropriate studies and imaging, such as MRIs, electroencephalograms (EEGs) and samples of spinal fluid.  

Nutt plans to enroll 20 Covid-19 patients who developed depression or another neuro-psychiatric condition into a study that will use Imperial’s state-of-the-art PET scanners to look for signs of brain inflammation or abnormalities in neurotransmitter levels.

In Baltimore, Stevens is also planning a long-term study on Covid-19 patients discharged from the ICU, which will also conduct brain scans as well as detailed cognitive tests on functions such as memory capacity.

And in Pittsburgh, through the Global Consortium Study of Neurological Dysfunction in Covid-19, Sherry Chou, a neurologist at the University of Pittsburgh, has coordinated scientists from 17 countries to collectively monitor the neurological symptoms of the pandemic, including through brain scans.

Corona virus being a new virus its essential that we share and learn from the data to work out the best treatment options for patients particularly patients where there are more long term neurological impacts technology can help us to do this.

Sources – John Hopkins Medicine https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

BBC –https://www.bbc.com/future/article/20200622-the-long-term-effects-of-covid-19-infection

https://www.bbc.co.uk/news/health-53081022

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