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COVID-19, the global pandemic that has infected over 10 million people globally and has claimed over 509,474 lives as of 30 June 2020, has been known to cause severe damage to the respiratory system. And now, more evidence emerging through extensive research suggests that patients also experience a vast range of neurological and psychiatric complications due to the onset of this disease.

Cough, fever and difficulty breathing are of course associated with the onset of COVID-19 infection, caused by the novel coronavirus known as SARS-CoV-2. Now, doctors and researchers are adding still more signs to the growing list of symptoms of the disease, such as the loss of smell and taste and altered mental state.

New research has pointed to almost half of the hospitalised patients experiencing some other symptoms concerning the central nervous system of the human body. The new set of symptoms relating to the nervous system include dizziness, loss of concentration, stroke and other problems, according to research published in the scientific journal Annals of Neurology.

The authors of the study indicate that the virus causes more harm to the body than just to the respiratory system of a patient as previously thought, and instead presents a "global threat" to the entire nervous system, including the brain, the spinal cord as well as the nerves.

  1. Neurological symptoms of COVID-19
  2. Effects of COVID-19 on the brain and central nervous system
  3. Other research on neurological symptoms of COVID-19
  4. Doctors for Neurological symptoms of COVID-19

Neurological imbalances or disorders maybe even earlier signs of the illness than flu-like symptoms. The known list of neurological symptoms of COVID-19 include:

In "Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study", an article published on 25 June 2020, in The Lancet Psychiatry, UK-based researchers presented data on patients who had experienced the psychological symptoms of COVID-19—this data was collected sometime between 2 April and 26 April by three medical associations in the UK.

Of the 125 patients in the study,

  • 62% had a cerebrovascular event. Of these:
    • 57 had an ischaemic stroke (when a blood clot blocks the supply of oxygen and blood to the brain)
    • Nine had an intracerebral haemorrhage (brain haemorrhage)
    • One had vasculitis of the central nervous system (swelling in the small blood vessels of the brain)
    • Most of these patients were older than 60 years.
  • 31% of patients were reported to have an altered mental state. Of these,
    • Nine had unspecified encephalopathy (brain damage)
    • Seven had encephalitis (swelling in the brain)
    • 23 met the criteria for altered mental status. Ten of these 23 patients experienced "new-onset psychosis", six had dementia-like problems (neurocognitive syndrome), four had a mood disorder. Twenty-one of these were new diagnoses; meaning these patients did not have altered mental state before the onset of COVID-19.

While this study gathered its data from the UK, it is a dipstick of what doctors everywhere are reporting: moderate to severe COVID-19 may be accompanied by altered mental state and psychosis in patients.

Doctors are now also recommending that recovered patients get themselves tested for post-traumatic stress disorder or PTSD.

Read more: Complications of severe COVID-19 infection

According to research published in the Annal of Neurology, significant neurological complications were also caused by previous coronavirus outbreaks like SARS in 2003 and MERS in 2013, although they were extremely rare. However, the researchers added that the overall number of cases for both those outbreaks combined was significantly lower than the COVID-19 outbreak, which began in late 2019 and is still on the rise.

The researchers studied neurological symptoms displayed by patients admitted in hospitals in China and France and observed the development of various neurological conditions among patients who tested positive for COVID-19.

Neurological conditions associated with COVID-19

Symptoms of the following neurological conditions were observed among patients who had tested positive for COVID-19:

Authors of the study also pointed out that patients, as well as healthcare workers, must be aware that many of the neurological symptoms may present in patients before the onset of respiratory symptoms or fever or cough become visible.

While the research published in Annals has elaborated on the many neurological disorders appearing in COVID-19 patients upon hospitalisation, several other studies have also researched the link between the new coronavirus infection and the neurological problems it may cause—either over the short term or long term.

One of the reasons why neurological problems may begin to show among patients may be the lack of oxygen reaching the brain due to the infection being caused by the SARS-CoV-2 virus, which according to the researchers, maybe the reason for the occurrence of strokes among some patients. (Read more: What is hypoxemia?)

Another study published in The New England Journal of Medicine suggested that as many as 65% of COVID-19 patients had experienced delirium as a symptom, which may present as significant cognitive changes highlighted by the feeling of disorientation, hallucinations, irritability or other similar experiences that a patient may feel after a long stay in intensive care.

Symptoms involving the nervous system also include the feeling of anxiety or panic attacks that have also been reported among COVID-19 patients who were admitted in the hospital. Healthcare workers and authorities have also called for people to keep a pulse oximeter handy to be able to monitor their own oxygen saturation levels in the blood, as a significant drop, or a reading below 94, may require a patient to visit the emergency room.

Dr. Arun R

Dr. Arun R

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Dr. Neha Gupta

Dr. Neha Gupta

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Dr. Lalit Shishara

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Dr. Alok Mishra

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References

  1. Koralnik IJ and Tyler KL. COVID ‐19: a global threat to the nervous system. Annals of Neurology. 2020 Jun.
  2. Carod-Artal FJ. Neurological Complications of Coronavirus and COVID-19. Rev Neurol. 2020 May; 70(9):311-322.
  3. Helms J et al. Neurologic Features in Severe SARS-CoV-2 Infection. New England Journal of Medicine. 2020 Jun; 382: 2268-2270.
  4. Mao L et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurology. 2020 Apr; 77(6):683-690.
  5. Aledo-Serrano A et al. Genetic Epilepsies and COVID-19 Pandemic: Lessons From the Caregiver Perspective. Epilepsia. May 2020; PMID: 32420620.
  6. Varatharaj A., Thomas N., Ellul M.A., Davies N.W.S., Pollak T.A., Tenorio E.L., et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The Lancet Psychiatry, Published online: 25 June 2020.
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