Scientists at the National Hospital, Queen Square began collecting data on patients with neurological symptoms in early March amid increasing reports of neurological issues associated with the virus.
Of the 43 patients whose data was collected, 10 suffered from encephalopathies with delirium and psychosis, 12 suffered from inflammatory CNS syndromes including encephalitis, acute disseminated encephalomyelitis (ADEM) and isolated myelitis, eight suffered from ischaemic strokes, eight suffered from peripheral neurological disorders, mostly diagnosed as Guillain-Barre syndrome, and five suffered from miscellaneous central disorders.
The scientists noted that the high number of cases of ADEM-like illness was "striking" and "warrants close surveillance." The number of cases reported in the Greater London area in five weeks was similar to the number usually expected over a period of five months, indicating an increased of ADEM with the coronavirus.
The neurological symptoms reported in the 43 patients included confusion, psychosis, seizures, hallucinations, delusions, necrosis, deteriorating vision and strokes, among other symptoms.
The severity of COVID-19 symptoms in the patients involved in the study varied from mild to critical. Neurological issues appeared from 6 days before and up to 27 days following the onset of COVID-19 symptoms.
"We’re seeing things in the way COVID-19 affects the brain that we haven’t seen before with other viruses," said Michael Zandi, a senior author on the study and a consultant at University College London’s Institute of Neurology and UCL Hospitals NHS foundation trust, according to The Guardian.
"What we’ve seen with some of these ADEM patients, and in other patients, is you can have severe neurology, you can be quite sick, but actually have trivial lung disease," added Zandi. “Biologically, ADEM has some similarities with multiple sclerosis, but it is more severe and usually happens as a one-off. Some patients are left with long-term disability, others can make a good recovery.”
A 55-year-old female patient mentioned in the study was admitted to the hospital after 14-days of experiencing fever, cough, muscle aches, breathlessness and difficulties smelling and tasting and was discharged three days later. The next day, her husband reported that she was disorientated, displaying ritualistic behavior such as putting her coat on and taking it off repeatedly and reporting auditory and visual hallucinations, including seeing lions and monkeys in her house. She was also intermittently aggressive towards her family and hospital staff. The psychotic symptoms remained even after her disorientation improved, but was trending towards improvement with continued treatment.
Zandi stressed that medical professionals should be aware of these complications and understand that issues that may usually be attributed to the recovery process may actually be nervous issues caused by the virus, according to The Guardian.
The study bolsters fears of lasting health effects caused by the coronavirus, including respiratory issues, numbness, weakness and memory issues that affect patients long after they've cleared the virus. Subtle brain damage caused by the virus could only become apparent in coming years, which may have happened in the 1918 Spanish flu pandemic, when up to a million people appeared to develop brain disease.
“It’s a concern if some hidden epidemic could occur after COVID-19 where you’re going to see delayed effects on the brain, because there could be subtle effects on the brain and slowly things happen over the coming years, but it’s far too early for us to judge now,” said Zandi.
“This is very important as we start to prepare post-COVID-19 rehabilitation programs,” said, David Strain, a senior clinical lecturer at the University of Exeter Medical School, according to The Guardian. “We’ve already seen that some people with COVID-19 may need a long rehabilitation period, both physical rehabilitation such as exercise, and brain rehabilitation. We need to understand more about the impact of this infection on the brain.”
The coronavirus is associated with a wide spectrum of neurological syndromes that affect the entire nervous system. Detailed neurological assessments of critically ill patients is difficult, complicating efforts by scientists to understand the nervous issues and thereby figure out treatment options. Throughout the study, the scientists stressed that there could be a number of causes for the neurological issues associated with the virus, but that further study was needed to fully understand these issues.
The scientists involved in the study stated that while similar neurological issues were reported in the SARS and MERS outbreaks in the past, the overall numbers of infected people were much lower and the number of those with neurological issues was low compared to the current pandemic.
Similar studies from around the world have reported similar issues. A study in the US found that patients who experienced delirium had higher mortality rates. A wide variety of symptoms have been reported among COVID-19 patients, including respiratory issues, a loss of sense of taste and smell, dermatological symptoms, cardiological issues and gastrointestinal issues.