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Confusion, seizure, strokes: How coronavirus may affect the brain

United State’s doctor urges people experiencing confusion and having problems thinking to also visit hospital and get tested.

A pattern is emerging among coronavirus patients arriving at hospitals in New York: beyond fever, cough and shortness of breath, some are deeply disoriented to the point of not knowing where they are or what year it is.

At times this is 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, the findings were raising concerns about the impact of the covid-19 on the brain and nervous system.

By now most people are familiar with the respiratory hallmarks of the coronavirus disease that has infected more than 2.2 million people around the world.

But more unusual signs are surfacing in new reports from the front lines.

What happens to the body when infected with coronavirus

A study published in the Journal of the American Medical Association last week found 36.4% of 214 Chinese patients had neurological symptoms ranging from loss of smell and nerve pain to seizures and strokes.

A paper in the New England Journal of Medicine this week examining 58 patients in Strasbourg, France found that more than half were confused or agitated with brain imaging suggesting inflammation.

You’ve been hearing that this is 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.

If you become confused if you’re having problems thinking, those are reasons to seek medical attention, he added.

The old mantra of ‘Don’t come in unless you’re short of breath’ probably doesn’t apply anymore.

Viruses and brain

It isn’t completely surprising to scientists that SARS-CoV-2 might impact the brain and nervous system, since this has been documented in other viruses, including HIV. Which can cause cognitive decline if untreated.

Viruses affect the brain in 1of 2 main ways, explained Michel Toledano, a neurologist at Mayo Clinic in Minnesota.

One is by triggering an abnormal immune response known as a cytokine storm that causes inflammation of the brain called autoimmune encephalitis.

The second is direct infection of the brain called viral encephalitis.

How might it happen?

The brain is protected by something called the blood brain-barrier. Which blocks foreign substances but could be breached if compromised.

However, since loss of smell is a common symptom of the covid-19, some have hypothesised the nose might be the pathway to the brain.

This remains unproven and the theory is somewhat undermined by the fact that many patients experiencing anosmia don’t go on to have severe neurological symptoms.

In the case of the novel covid-19 doctors believe based on the current evidence the neurological impacts are more likely the result of overactive immune response rather than brain invasion.

To prove the latter even happens the virus must be detected in cerebrospinal fluid.”

This has been documented once in a 24 year-old Japanese man whose case was published in the International Journal of Infectious Disease.

The man developed confusion and seizures and imaging showed his brain was inflamed, but since this is the only known case so far and the virus test hasn’t yet been validated for spinal fluid scientists remain cautious.

Some More research needed

All of this emphasises the need for some more research.

Frontera, who is also a professor at New Yourk university School of Medicine, is part of an international collaborative research project to standardise data collection.

Her team is documenting striking cases including seizures in coronavirus patients with no prior history of the episodes and unique new patterns of tiny brain hemorrhages.

One startling finding concerns the case of a man in his fifties whose white matter the parts of the brain that connect brain cells to each other was so severely damaged it would basically render him in a state of profound brain damage, she said.

The doctors are stumped and want to tap his spinal fluid, for a sample.

Brain imaging and spinal taps are difficult to perform on patients on the ventilators, and since most die. The full extent of neurologic injury isn’t yet known.

But neurologists are being called out for the minority of patients who survive being on the ventilator.

We are seeing a lot of consults of patients presenting in confusional states, Rohan Arora, a neurologist at the Long Island Jewish Forest Hills hospital told. saying that describes more than 40% of recovered virus patients.

It’s not yet known whether the impairment is long term and being in the ICU itself can be a disorienting experience, as a result of factors including strong medications.

But returning to normal appears to be taking longer than for people who suffer heart failure or stroke added Arora.”

HEADER: Thailand’s Health Minister Anutin Charnvirakul (R) views closed circuit video images in Bamrasnaradura Infectious Disease Institute outside Bangkok where patients infected with covid-19 are being confined.

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