Brain complications from COVID-19

On March 11, 2020, SARS-CoV-2 was declared a pandemic, a virus primarily affecting the respiratory system. Within months, neurological disorders such as a lack of smell and taste, dizziness and headaches have also been reported. As the virus continued to spread from Wuhan to neighboring countries and continents, the prevalence and severity of these neurological and psychiatric cases increased.

There has been a glaring lack of nationwide surveillance studies on the neurological and psychiatric symptoms of COVID-19, with only a handful of case studies and two small population studies in Wuhan and France.

There are many vital questions to answer regarding the neurological and psychiatric effects of COVID. How common are neurological and psychiatric complications in COVID-19 patients? How much affects the central nervous system compared to the peripheral nervous system, and are new syndromes appearing? And who is at risk?

The CoroThe Nerve Studies group is a collaborative effort to track suspected neurological complications of COVID-19. A paper published late last year aimed to answer some of these questions in a UK cohort.

Collaboration between different clinical neuroscience specialties

To assess cases of neurological and psychiatric symptoms of COVID-19, an online rapid response case report network has been developed, with the collaboration of various clinical neuroscience specialties led by the CoroGroup of nervous studies.

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Patients were stratified into a younger group (under 60) and an older group (over 60), and symptoms were grouped into broader clinical syndromes associated with COVID-19 and categorized into case definitions , including ‘Cerebrovascular event (abnormalities of blood flow in the brain)’, ‘Altered mental state’, ‘Peripheral neurology’ and ‘Encephalitis’.

Members of these professional organizations identified patients with these syndromes and a rapid 5-minute clinical data set was completed. It contained four essential elements: the diagnosis of COVID-19, demography, geography and the nature of the clinical syndrome.

What do these collaborative clinical data sets reveal?

153 unique cases meeting UK clinical case definitions have been identified. The ages ranged from 23 to 94, with the median age being 71. Overall, 49% of cases were notified via BASP, 35% via ABN / and 16% via the RCPsych portal. Of 153 cases, those without complete clinical data sets were excluded, leaving 125 cases.

Of the entire cohort with complete data (125), 62% (77) presented with a cerebrovascular event and 31% (39) of patients presented with altered mental status, collectively accounting for 93% of neurological and psychiatric disorders. Within these subgroups, encephalopathy and encephalitis accompanied 41% of patients with altered mental status, and stroke was the most common cerebrovascular event (74%).

96% of the datasets had demographic data by age. There was a disproportionate number of neuropsychiatric presentations in younger patients (49% [18]) compared to cerebrovascular events (18% [13]) and a predominance of cerebrovascular complications in older patients (82% [61]).

The future of the COVID-Clinical Neuroscience study

This is an early indicator of the link between new acute psychiatric complications in a younger cohort and COVID-19. The uneven number of older cohorts with cerebrovascular complications could be explained by the health of the aging brain and the risk factors associated with it, with these problems being exacerbated by serious illness.

This study was the first snapshot of acute neurological and psychiatric complications in adults hospitalized with COVID-19. Funded by the MRC COVID-CNS The study led by Dr Benedict Michael is the next step in data collection and is a collaborative effort of more than 10 sites across the UK. This study will explore two key questions: for whom does COVID-19 cause injury? What specific mechanisms cause this damage?

© Prasesh Shiwakoti (Lomash) / Unsplash

This in-depth clinical, laboratory and imaging study will compare COVID-19 patients with neurological / psychiatric complications, a control cohort with COVID-19 without neurological / psychiatric complications and another with respiratory problems without COVID-19.

Markers of brain damage, inflammation, and brain CT changes will be assessed in these patients, along with the assessment of symptoms, signs and brain function at different time points. This will be essential in understanding which existing drugs to use, such as antivirals, or whether new drugs need to be developed to treat these neurological effects.

Collaborations are essential for a meaningful response

Data sharing and open collaborations are essential to facilitate clinical research that has been relevant to the developments of COVID-19. Once this more in-depth study is carried out, risk groups can be more easily identified and mechanistic tests will deepen the impact of the disease on the central nervous system.

Preparation and collaborations for future pandemics, and not just in neurological and psychiatric syndromes, will be the driving force behind the rapid deployment of diagnostic, containment and eradication strategies.

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