Acute Neurological Syndromes Associated with COVID-19: A report of 40 patients with strokes, paralysis, encephalomyelitis, and other syndromes: Brain Journal

EM of sars-cov-2 budding from apoptotic (dying) cells–NIAID

This report in Brain Neurology Journal on July 8 gives details of 40 patients with acute neurological syndromes related to COVID-19.  The first group is those with stroke, patients with large blood clots in major arteries leading to the brain; most have made only minimal recoveries.  Another group had acute encephalomyelitis– some responded to corticosteroids and made partial recoveries.  A third had acute encephalopathies with delirium or psychosis but no findings on MRI scans– most of these recovered.  A fourth group had peripheral nerve disorders, some similar to Guillain-Barre Syndrome, with paralysis.  A fifth group had difficult-to-categorize problems.

From the abstract: “SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature…”

This is an abstruse academic paper with many details for neurologists and other involved disciplines.  The point of the paper for amateurs is that COVID-19 often affects the brain and nerves as well as the lungs.  There are many cases, even in relatively mild illnesses, in which cough and fever are not the only problems.  Patients who have mental symptoms or nerve problems should not feel that they are imagining things.

Many patients with apparently mild illness find that their reflexes are off, they have weakness, or they have clumsiness, even difficulty walking.  There are also frequent reports of hallucinations, often worse at night.  These symptoms are due to an as-yet unexplained effect of the virus on brain and nerves– not a direct infection, apparently, but an immune response.

Another issue is that many of these symptoms appear after the acute illness or persist long after one would expect to have recovered.  The vast majority of illnesses have occurred in the last three months, and many of those affected have still not fully recovered.  It remains to be seen how long these symptoms will last, or even if some of them may be permanent.  We have a great deal to learn about this virus.