COVID-19 CAN/MAY AFFECT THE BRAIN

Jayashree Nandi n letters@hindustantimes.com NEW DELHI: The coronavirus disease (Covid-19) can, in some instances, lead to disorientation or delirium, say neurologists treating Covid-19 patients. While the focus has so far been on the effect of the disease on the respiratory system, as doctors treat more patients, they are noticing and document new patterns. Neurologists are worried that some patients may be showing only neurological symptoms — not other common symptoms such as fever and cough. If they are not monitored, diagnosis may be delayed. “Elderly patients with an infection, any infection including urinary tract infection, can develop delirium. The general symptoms with fever could be confusion (delirium, encephalopathy). Loss of taste and smell are likely at the level of receptors in the mucosa,” said Dr Vivek Mathew, professor of neurology at Christian Medical College, Vellore which is treating Covid-19 patients. A study published in the Journal of the American Medical Association on April 10 based on data collected from January 16 to February 19 at three Covid-19 care centers in Wuhan — it included 214 hospitalised patients — found that 36.4% showed neurological manifestations. Compared to patients with non-severe infection, patients with severe infection were older and had more underlying disorders. These patients showed fewer typical symptoms such as fever and cough but more neurologic symptoms. Dr Col JD Mukherji, principal director and head of neurology at Max Super Specialty Hospital who is treating some Covid-19 patients says it’s still early days for India. “The general symptoms of the disease are headache, loss of smell and taste, fever, confusion. In China, cases of strokes, seizure and muscle injury have also been documented. We are on a learning curve in India. All of us will start seeing these cases as the numbers rise,” said Dr Mukherji. He listed the four ways in which the virus can affect the brain: direct viral injury, causing symptoms like viral encephalitis; an excessive immune response called cytokine storm which can damage the brain; unintended host- immune response where the immune response damages some other structure altogether “like the five cases of Guillain-Barré syndrome documented in Italy”; and indirectly, “in those whose immune response has been deliberately reduced through medication due to conditions such as myasthenia gravis (a neuromuscular disease) or multiple sclerosis”. “There are no medicines for these neurological symptoms yet. If the entire body is in a cytokine storm, a monoclonal antibody can be used but they are expensive and may not be made available widely. In an Indian setting, some steroids can be used which needs to be studied and decided,” said Dr Shamsher Dwivedi, chairman, PSRI Institute of Neurosciences. Delhi.

My worry is during the next few years, are we going to witness similar clinical profile in some of the survivors of COVID -19 Pandemic.

Read this below.
After Spanish Flu of 1918-27 we had similar presentations.

“Von Economo’s encephalitis is a neuropsychiatric disorder of possible autoimmune origin, which affects basal ganglia. This reaction may occur secondary to infection by different viral or bacterial agents. Given that it appears after the acute episode has

disappeared, molecular mimetism has been proposed to explain the autoimmune lesion. Several cases have been reported through time, but it was with the 1918 flu pandemic, known as the Spanish flu, that lethargic encephalitis reached epidemic levels with cases reported until 1923 in various countries. The Spanish flu pandemic appeared in Colombia at the end of 1918 in several cities, but it affected especially Bogotá where the highest number of patients and deaths was reported. Our purpose with the present work was to commemorate the arrival of the Spanish flu to our country after one hundred years, as well as to reflect on its main complications, which included some lethargic encephalitis cases.”

PMID:

31021542 DOI:

10.7705/biomedica.v39i1.4677

Its better to be aware of this fact. Dr.T.P. Sudhakar,

Professor of Psychiatry, AIMSR, Chittoor. (A.P)

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