While most of the symptomatic focus of COVID-19 has been on the respiratory effects of the virus, other manifestations of the disease are beginning to come to light as more data are collected and people who were previously infected with COVID-19 survive their infection and continue to be monitored. A new review in JAMA Neurology provides information on how COVID-19 may affect the brain. According to the authors, there had been no previous reports of patients displaying neurological changes as a result of the virus.
As part of their retrospective case series, the authors of this recent article collected data between January 16 and February 19 of this year from 3 care centers in Wuhan, China. The study population included 214 patients diagnosed with COVID-19, the average age of whom was 52.7 years. Women represented about 60% of the sample.
Of these 214 patients, 88 (or 41.1%) suffered severe COVID-19 infection. Consistent with what we know about this virus, these patients were also more likely to be older and to have other pre-existing health conditions. The most common observed underlying disorder was hypertension. Those with more severe infections were also more likely to lack typical COVID-19 symptoms like fever and cough.
To investigate the neurological impact of COVID-19, neurologists evaluated the extracted clinical data for neurological symptoms, which they designated into 3 separate categories: central nervous system manifestations, peripheral nervous system manifestations, and skeletal muscular injury manifestations. They found that 78 patients – or just over 36% of their study population – displayed some sort of neurological manifestation of COVID-19.
Patients with more severe infections were more likely to have these neurological manifestations, the majority of which were of the central nervous system type. For example, whereas only 2.4% of those with non-severe COVID-19 suffered impaired consciousness, nearly 15% of those with severe infection had impaired consciousness.
These results suggest that COVID-19 is associated with neurological manifestations and that patients, especially in sicker patients. According to the authors, physicians who observe neurological manifestations in patients with COVID-19 should consider that the patient is suffering a severe infection. Once more data are collected, we are likely to gain a better understanding of the frequency and nature of the impact of this new virus on the brain.
Mao, L. et al. (2020). Neurological manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China, JAMA Neurology, 77(6), 683-690.