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Neurologic Manifestations Of COVID-19


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Watched the author discuss this article she'd just posted 4hrs prior to Forbes during MSNBC's the 11th Hour with Brian Williams. Need to include neurology symptoms in screening for Covid-19. Karen

Forbes April 27, 2020

Lipi Roy, MD, MPH

Viral Brain Attack: Neurologic Manifestations Of COVID-19


Early on in the novel coronavirus pandemic, we were warned about three cardinal symptoms associated with COVID-19: fever, cough and shortness of breath – symptoms commonly connected to most respiratory viral illnesses. But no longer. As each day goes by, we learn more and more about how this pathogen attacks the human body. Neurological signs and symptoms are among a growing list of clinical manifestations associated with SARS-CoV-2 which, at the time of this article’s publication, has resulted passed the 1 million mark in cases and has claimed 56,000+ lives in the U.S.

“It’s certainly clear that patients with COVID-19 experience generic constitutional symptoms such as dizziness and headache which are fairly common,” said Christa Swisher, MD, neurologist and neurocritical care specialist at the Duke University Department of Neurology . Dr. Swisher added: “There’s also a subset of patients that experience peripheral nervous system manifestations such as rhabdomyolysis and anosmia.”...

...What are Neurologic Symptoms Associated with COVID-19?

Of the 36% of patients with neurologic manifestations, 24.8% had central nervous system (CNS) symptoms, 8.9% had peripheral nervous system (PNS) symptoms and 10.7% had skeletal muscle injury symptoms. The CNS consists of the brain and spinal cord whereas the PNS includes all the nerves outside the brain and spinal cord. Among CNS manifestations, the most common symptoms were dizziness (16.8%) and headache (13.1%); the most common PNS symptoms were impaired taste (5.6%) and smell (5.1%).

Nervous system issues were more common among patients with severe infections who tended to be older and more likely to have an underlying illness, often hypertension. These patients experienced acute cerebrovascular disease (I.e. ischemic and hemorrhagic strokes), impaired consciousness and seizure. Most neurologic symptoms – other than strokes and altered consciousness – occurred early in the disease course, median of 1-2 days. The authors also noted that some patients presented to the hospital only with neurologic symptoms as opposed to the typical triad of fever, cough or dyspnea....

What’s the Mechanism?

The exact pathophysiology is unclear. The authors hypothesize that SARS-CoV-2 is attacking the nervous system in a manner similar to that of the SARS and MERS viruses. Low levels of lymphocytes – a subset of white blood cells that fight infection – among patients with COVID-19 and CNS symptoms suggests immunosuppression, particularly among those with severe infection.

“While the exact mechanism of neurological involvement remains uncertain, it is likely a combination of direct viral invasion as well as the secondary effects of the immunologic and inflammatory responses directed towards the nervous system,” according to Thomas Pitts, MD, a neurologist and clinical neurophysiologist and Director of Neurology at New York City’s Hudson Medical.

Patients with severe infection were also found to have higher levels of d-dimer, a protein fragment associated with high levels of blood clot formation and breakdown. These findings are consistent with recent a phenomenon described by the American Society of Hematology as COVID-19-associated coagulopathy. In other words, patients with COVID-19 are exhibiting a high burden of clots in various parts of their body: lower extremities, lungs and the brain, with the latter two presenting as pulmonary emboli and ischemic strokes, respectively....