Coronavirus: Rise in delirium and nerve damage among patients

Researchers have found that a number of patients who have tested positive for coronavirus have suffered from neurological complications, including delirium, brain inflammation, stroke and nerve damage.

A new study led by University College London (UCL) and University College London Hospitals (UCLH) found a “rare and sometimes fatal inflammatory condition” known as ADEM (acute disseminated encephalomyelitis) linked to Covid-19 that appears to be rising in prevalence.

Forty-three patients aged between 16 to 85 who had either confirmed or suspected Covid-19 were included in the study, published in the journal Brain. All were treated at the National Hospital for Neurology and Neurosurgery at UCLH.

Ten cases of temporary brain dysfunction, known as transient encephalopathies, with delirium were identified among those in the study, as well as 12 cases of brain inflammation, eight cases of strokes and eight others with nerve damage, said the authors.

Dr Michael Zandi, joint senior author of the study from UCLH, said: “We identified a higher than expected number of people with neurological conditions such as brain inflammation, which did not always correlate with the severity of respiratory symptoms.

“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 lethargic outbreak in the 1920s and 1930s after the 1918 influenza pandemic — remains to be seen.”

Nine of the 12 cases of brain inflammation were diagnosed with ADEM, which can be triggered by viral infections, but is rare and typically seen in children. The UCL team usually sees about one adult patient with ADEM per month, but this has increased to at least one per week during the study period.

The study also added detail to another recent study involving authors from the UCL Queen Square Institute of Neurology, identifying 153 people with neurological complications from coronavirus, and confirmed a higher than expected number of patients with stroke due to “excessive stickiness” in blood found in Covid-19 patients.

The UCL study comes after a report published in The Lancet highlighted that encephalopathy had been reported in 16 of 214 hospitalised Covid-19 patients in Wuhan and 40 of 58 patients in intensive care in France.

Warning that although the number of infections that may lead to neurological disease will “probably remain small”, these patients may be left with “severe neurological sequelae”, which refers to the long-term consequences of a previous disease of injury.

Researchers called for further research to identify why coronavirus patients were developing the neurological complications.

Dr Ross Paterson, joint first author of the UCL study, said: “Given that the disease has only been around for a matter of months, we might not yet know what long-term damage Covid-19 can cause.

“Doctors need to be aware of possible neurological effects, as early diagnosis can improve patient outcomes. People recovering from the virus should seek professional health advice if they experience neurological symptoms.”

“With so many people infected, the overall number of neurological patients and their associated health burden and social and economic costs might be large.

“Health care planners and policymakers must prepare for this eventuality, while the many ongoing studies investigating neurological associations increase our knowledge base,” said The Lancet’s report.

Joint senior author Dr Hadi Manhi said the study was the first to amalgamate clinical presentations of coronavirus patients with neurological disease.

“This now sets up a template for other researchers around the world, facilitating coordinated research to optimise the diagnosis and treatment of these complications, which to date has proved difficult. In addition, patients are going to require long-term follow up,” she added.