A pattern is emerging among COVID-19 patients arriving at hospitals in New York: beyond fever, cough and shortness of breath, some are deeply disoriented to the purpose of not knowing where they’re or what year it’s.
At times this is often linked to low oxygen levels in their blood, but in certain patients, the confusion appears disproportionate to how their lungs are faring.
Jennifer Frontera, a neurologist at NYU Langone Brooklyn hospital seeing these patients, told AFP the findings were raising concerns about the impact of the coronavirus on the brain and systema nervosum.
By now, the general public is conversant in the respiratory hallmarks of the COVID-19 disease that has infected quite 2.2 million people around the world.
But bizarre signs are surfacing in news reports from the front lines.
A study published within the Journal of the American Medical Association last week found 36.4 per cent of 214 Chinese patients had neurological symptoms starting from loss of smell and nerve pain to seizures and strokes.
A paper within the geographic area Journal of medication in the week examining 58 patients in Strasbourg, France found that quite half were confused or agitated, with brain imaging suggesting inflammation.
“You’ve been hearing that this is often a breathing problem, but it also affects what we most care about, the brain,” S Andrew Josephson, chair of the neurology department at the University of California, the urban centre told AFP.
“If you become confused if you’re having problems thinking, those are reasons to hunt medical attention,” he added.
“The old mantra of ‘Don’t are available in unless you’re in need of breath’ probably doesn’t apply anymore.”
Viruses and the brain
It isn’t completely surprising to scientists that SARS-CoV-2 might impact the brain and systema nervosum since this has been documented in other viruses, including HIV, which may cause cognitive decline if untreated.
Viruses affect the brain in one in all two main ways, explained Michel Toledano, a neurologist at Mayo Clinic in Minnesota.
One is by triggering an abnormal immune reaction referred to as a cytokine storm that causes inflammation of the brain — called autoimmune encephalitis.
The second could be a direct infection of the brain, called viral encephalitis.
How might this happen?
The brain is protected by something called the blood-brain-barrier, which blocks foreign substances but might be breached if compromised.
However, since the loss of smell could be a common symptom of the coronavirus, some have hypothesised the nose may be the pathway to the brain.
This remains unproven — and therefore the theory is somewhat undermined by the actual fact that several patients experiencing anosmia don’t persist to own severe neurological symptoms.
In the case of the novel coronavirus, doctors believe supported this evidence the neurological impacts are more likely the results of overactive immune reaction instead of brain invasion.
To prove the latter even happens, the virus must be detected in bodily fluid.
This has been documented once, during a 24-year-old Japanese man whose case was published within the International Journal of communicable disease.
The man developed confusion and seizures, and imaging showed his brain was inflamed. But since this is often the sole known case thus far, and therefore the virus test hasn’t yet been validated for humor, scientists remain cautious.
More research needed
All of this emphasises the requirement for more research.
Frontera, who is additionally a professor at NYU School of medication, is an element of a global collaborative scientific research to standardise data collection.
Her team is documenting striking cases including seizures in COVID-19 patients with no prior history of the episodes, and “unique” new patterns of little brain haemorrhages.
One startling finding concerns the case of a person in his fifties whose nerve tissue — the parts of the brain that connect brain cells to every other — was so severely damaged it “would basically render him during a state of profound brain damage,” she said.
The doctors are stumped and need to tap his humor for a sample.
Brain imaging and spinal taps are difficult to perform on patients on ventilators, and since most die, the complete extent of neurologic injury isn’t yet known.
But neurologists are being called out for the minority of patients who survive to get on a ventilator.
“We’re seeing plenty of consults of patients presenting in confusional states,” Rohan Arora, a neurologist at the Long Island Jewish Forest Hills hospital told AFP, saying that describes quite 40pc of recovered virus patients.
It’s not yet known whether the impairment is long run, and being within the ICU itself will be a disorienting experience as a results of factors including strong medications.
But returning to normal appears to be taking longer than for those that suffer heart disease or stroke, added Arora.
HEADER: Thailand’s Health Minister Anutin Charnvirakul (R) views closed-circuit video images in Bamrasnaradura communicable disease Institute outside Bangkok where patients infected with coronavirus are being confined.