COVID-19: are delirium, brain inflammation and stroke common complications?

Written by Sharon Salt, Senior Editor

A recent study published in Brain has reported that the possible neurological complications of COVID-19 can include delirium, brain inflammation, stroke and nerve damage. It has also been suggested that these symptoms could be present even in the absence of severe respiratory symptoms due to COVID-19. 

The researchers identified acute disseminated encephalomyelitis (ADEM) – a rare and sometimes fatal inflammatory condition – to be increasing in prevalence due to the pandemic.

It was also noted that some study participants did not experience severe respiratory symptoms and the neurological disorder was their first and main presentation of COVID-19.

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“We should be vigilant and look out for these complications in people who have had COVID-19. Whether we will see an epidemic on a large scale of brain damage linked to the pandemic – perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic – remains to be seen,” commented joint senior author of the paper, Michael Zandi (UCL Queen Square Institute of Neurology, London, UK).

Within the study, 43 people (aged 16–85) were included who had either confirmed or suspected COVID-19. The team identified ten cases of transient encephalopathies with delirium, a finding that corresponds with other studies finding evidence of delirium with agitation. Additionally, there were 12 cases of brain inflammation, eight cases of strokes and eight cases of nerve damage (mainly Guillain–Barré syndrome).

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Most patients who had brain inflammation conditions were diagnosed with ADEM (nine out of 12 cases). On average, the London-based team typically see one adult patient per month with ADEM, however, this number increased to at least one per week during the study period.

When testing cerebrospinal fluid samples from the patients, the researchers noted that SARS-CoV-2 was not present. This suggests that the virus does not directly attack the brain to cause neurological complications. In some patients there was evidence that the brain inflammation was likely caused by an immune response, which implies that some neurological complications may be due to the immune response rather than the virus itself.

These findings add clinical descriptions and detail to recent studies examining the neurological complications from COVID-19.

“Our study amalgamates, for the first time, the clinical presentations of patients with COVID-19 neurological disease with MRI and laboratory features including, in one case, a brain biopsy. This now sets up a template for other researchers around the world, facilitating coordinated research to optimize the diagnosis and treatments of these complications, which to date, has proved difficult. In addition, patients are going to require long-term follow up,” concluded joint senior author, Hadi Manji (National Hospital for Neurology and Neurosurgery, London, UK).

Sources: Paterson RW, Brown RL, Benjamin L et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain doi:10.1093/brain/awaa240 (2020); www.uclh.nhs.uk/News/Pages/neurologicalcomplicationsCOVID19.aspx