Virus World

SARS-CoV-2 generally attacks the lungs, but researchers are also stressing its effects on the brain in a fraction of patients. Newly described case reports add to growing evidence that COVID-19 infections can result in severe, long-lasting neurological complications—including inflammation, psychosis, delirium, nerve damage, and strokes—even among patients experiencing mild cases of the virus with few other symptoms. In some instances, the new study claims, these neurological effects were the first manifestation of the disease. In a paper published today (July 8) in the journal Brain, neurologists in the UK noted an uptick this spring in cases of a potentially fatal condition called acute disseminated encephalomyelitis (ADEM). While ADEM is usually diagnosed in younger children after a viral infection, researchers at the college’s Institute of Neurology tell The Guardian that they saw two or three cases per week among coronavirus patients during April and May. Ordinarily, the hospital sees about two ADEM cases per month among adults. “We’re seeing things in the way Covid-19 affects the brain that we haven’t seen before with other viruses,” says Michael Zandi, a consulting neurologist at the university’s hospital and the study’s senior author. “What we’ve seen with some of these Adem patients, and in other patients, is you can have severe neurology, you can be quite sick, but actually have trivial lung disease,” he adds.

COVID-19 is primarily a respiratory disease that attacks the lungs, but it has also manifested seemingly unrelated symptoms, such as a loss of taste and smell or memory loss, that can persist for months beyond the initial diagnosis. These oddities suggest a neurological source. The study detailed the neurological symptoms of 43 patients hospitalized in the National Hospital for Neurology and Neurosurgery in London with confirmed or suspected cases of COVID-19. A dozen were diagnosed with inflammation of the central nervous system, including nine cases of ADEM. A further 10 patients experienced delirium or psychosis. Eight patients suffered strokes, including one that was fatal, and another eight had peripheral nerve damage. At least two patients also developed strange behaviors shortly after being discharged from the hospital. One woman, as described in the paper, repeatedly donned and took off her coat, and began hallucinating lions and monkeys inside her home. Another woman became drowsy and ultimately needed emergency surgery to relieve the pressure on her brain...

For three months, Chelsea Alionar has struggled with fevers, headaches, dizziness and a brain fog so intense it feels like early dementia. She came down with the worst headache of her life on March 9, then lost her sense of taste and smell. She eventually tested positive for the coronavirus. But her symptoms have been stranger, and lasted longer, than most. “I tell the same stories repeatedly; I forget words I know,” she told me. Her fingers and toes have been numb, her vision blurry and her fatigue severe. The 37-year-old is a one of the more than 4,000 members of a Facebook support group for Covid survivors who have been ill for more than 80 days.

The more we learn about the coronavirus, the more we realize it’s not just a respiratory infection. The virus can ravage many of the body’s major organ systems, including the brain and central nervous system. Among patients hospitalized for Covid-19 in Wuhan, China, more than a third experienced nervous system symptoms, including seizures and impaired consciousness. Earlier this month, French researchers reported that 84 percent of Covid patients who had been admitted to the I.C.U. experienced neurological problems, and that 33 percent continued to act confused and disoriented when they were discharged.

According to Dr. Mady Hornig, a psychiatrist and epidemiologist at the Columbia University Mailman School of Public Health, the possibility that neurological issues “will persist and create disability, or difficulties, for individuals downstream is really looking more and more likely.” Infections have long been implicated in neurological diseases. Syphilis and H.I.V. can induce dementia. Zika is known to invade developing brains and limit their growth, while untreated Lyme disease can cause nerve pain, facial palsy and spinal cord inflammation. One man with SARS developed delirium that progressed into coma, and was found to have the virus in his brain tissue after his death.