Michael Coston
Editor, Senior Moderator
COVID-19: Another Neurological Study To Ponder
#15,352
The popular perception of COVID-19 disease is that somewhere around 1% to 2% of (mostly elderly) patients die from the disease, while 98% survive. While perhaps statistically correct, outcomes aren't necessarily as neat and tidy as that.
We've seen anecdotal reports of many patients who remain sick or severely weakened months after infection, and numerous studies finding evidence of serious cardiac, pulmonary, and neurological sequelae.
Three months ago, in JAMA: Neurologic Manifestations Of Patients With Severe Coronavirus Disease, we looked at reports that more than 1/3rd of a study group of 214 patients hospitalized with COVID-19 in Wuhan, China showed signs of neurological involvement.
Neurological manifestations ranged from relatively mild (headaches, dizziness, anosmia, mild confusion, etc.) to more profound (seizures, stupor, loss of consciousness, etc.) to potentially fatal (ischemic stroke, cerebral hemorrhage, muscle injury (rhabdomyolysis), etc.).
Of note, in this study neurological symptoms were detected in 30.2% of non-severe cases, and nearly half (45.5%) of severe cases. While some of these lingering effects may eventually resolve, for many survivors, long-term impairment is a real possibility.
And even those sequelae that appear subtle or minor today, may have the potential to worsen over time.
Two weeks ago, in The Lancet: Yet Another Study On Neurological Manifestations In Severe COVID-19 Patients, we looked at a study that described 153 COVID-19 cases treated in UK hospitals presenting with a wide range of neurological and psychiatric complications, affecting both younger and elderly patients.
Today, we've yet another study, published this time in the journal Brain that reinforces these concerns. I've only posted the abstract, so follow the link to download and read the full 63 page PDF.
The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings
Ross W Paterson, Rachel L Brown, Laura Benjamin, Ross Nortley, Sarah Wiethoff, Tehmina Bharucha, Dipa L Jayaseelan, Guru Kumar, Rhian E Raftopoulos, Laura Zambreanu ... Show more
Brain, awaa240, https://doi.org/10.1093/brain/awaa240
Published: 08 July 2020 Article history
PDF
Abstract
Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness.
Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria.
Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged:
(i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only;
(ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died;
(iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barr? syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and
(v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies.
The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking.
This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms, which will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.
(Continue . . . )
While most people assume you either survive or (rarely) die from COVID-19, outcomes are not nearly as binary as that. Some survivors of the pandemic virus - even very young ones - may require long-term rehabilitation and assistance, and some may remain permanently disabled.
Three weeks ago, in The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?, we revisited the history of the EL epidemic of 100 years ago (concurrent with, and following the 1918 Spanish flu), and a very brief (1-page) focal point opinion (published in The Lancet), that urged us not to underestimate the potential long-term sequelae from COVID-19.
Follow the link below to read the opinion.
COVID-19: can we learn from encephalitis lethargica?
Antonino Giordano, Ghil Schwarz, Laura Cacciaguerra, Federica Esposito, Massimo Filippi
Published:July, 2020
DOI: https://doi.org/10.1016/S1474-4422(20)30189-7
While there is no compelling evidence suggesting we are on the brink of a repeat of that global epidemic of neurological disease, there is still much we don't know about the long-term effects of SARS-COV-2 infection on the human body.
For now there is more than enough evidence of serious and potentially long-lasting damage among some percentage of COVID survivors. While most healthy individuals will still find the infection mild, and will fully recover, the prognosis for others is not always as sanguine.
Some other recent on-topic studies have included:
JAMA Neurology: Elevated Risk of Ischemic Stroke With COVID-19
PrePrint: Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19
CDC HAN: Multisystem Inflammatory Syndrome In Children (MIS-C)
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young
EID Journal: Two Reports On Thrombotic Events In COVID-19 Patients
EID Journal: Pulmonary Embolism and Increased Levels of d-Dimer in COVID-19 Patients
https://afludiary.blogspot.com/2020/...-study-to.html
#15,352
The popular perception of COVID-19 disease is that somewhere around 1% to 2% of (mostly elderly) patients die from the disease, while 98% survive. While perhaps statistically correct, outcomes aren't necessarily as neat and tidy as that.
We've seen anecdotal reports of many patients who remain sick or severely weakened months after infection, and numerous studies finding evidence of serious cardiac, pulmonary, and neurological sequelae.
Three months ago, in JAMA: Neurologic Manifestations Of Patients With Severe Coronavirus Disease, we looked at reports that more than 1/3rd of a study group of 214 patients hospitalized with COVID-19 in Wuhan, China showed signs of neurological involvement.
Neurological manifestations ranged from relatively mild (headaches, dizziness, anosmia, mild confusion, etc.) to more profound (seizures, stupor, loss of consciousness, etc.) to potentially fatal (ischemic stroke, cerebral hemorrhage, muscle injury (rhabdomyolysis), etc.).
Of note, in this study neurological symptoms were detected in 30.2% of non-severe cases, and nearly half (45.5%) of severe cases. While some of these lingering effects may eventually resolve, for many survivors, long-term impairment is a real possibility.
And even those sequelae that appear subtle or minor today, may have the potential to worsen over time.
Two weeks ago, in The Lancet: Yet Another Study On Neurological Manifestations In Severe COVID-19 Patients, we looked at a study that described 153 COVID-19 cases treated in UK hospitals presenting with a wide range of neurological and psychiatric complications, affecting both younger and elderly patients.
Today, we've yet another study, published this time in the journal Brain that reinforces these concerns. I've only posted the abstract, so follow the link to download and read the full 63 page PDF.
The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings
Ross W Paterson, Rachel L Brown, Laura Benjamin, Ross Nortley, Sarah Wiethoff, Tehmina Bharucha, Dipa L Jayaseelan, Guru Kumar, Rhian E Raftopoulos, Laura Zambreanu ... Show more
Brain, awaa240, https://doi.org/10.1093/brain/awaa240
Published: 08 July 2020 Article history
Abstract
Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness.
Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria.
Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged:
(i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only;
(ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died;
(iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barr? syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and
(v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies.
The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking.
This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms, which will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.
(Continue . . . )
While most people assume you either survive or (rarely) die from COVID-19, outcomes are not nearly as binary as that. Some survivors of the pandemic virus - even very young ones - may require long-term rehabilitation and assistance, and some may remain permanently disabled.
Three weeks ago, in The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?, we revisited the history of the EL epidemic of 100 years ago (concurrent with, and following the 1918 Spanish flu), and a very brief (1-page) focal point opinion (published in The Lancet), that urged us not to underestimate the potential long-term sequelae from COVID-19.
Follow the link below to read the opinion.
COVID-19: can we learn from encephalitis lethargica?
Antonino Giordano, Ghil Schwarz, Laura Cacciaguerra, Federica Esposito, Massimo Filippi
Published:July, 2020
DOI: https://doi.org/10.1016/S1474-4422(20)30189-7
While there is no compelling evidence suggesting we are on the brink of a repeat of that global epidemic of neurological disease, there is still much we don't know about the long-term effects of SARS-COV-2 infection on the human body.
For now there is more than enough evidence of serious and potentially long-lasting damage among some percentage of COVID survivors. While most healthy individuals will still find the infection mild, and will fully recover, the prognosis for others is not always as sanguine.
Some other recent on-topic studies have included:
JAMA Neurology: Elevated Risk of Ischemic Stroke With COVID-19
PrePrint: Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19
CDC HAN: Multisystem Inflammatory Syndrome In Children (MIS-C)
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young
EID Journal: Two Reports On Thrombotic Events In COVID-19 Patients
EID Journal: Pulmonary Embolism and Increased Levels of d-Dimer in COVID-19 Patients
https://afludiary.blogspot.com/2020/...-study-to.html