Stroke, delirium, anxiety, confusion, fatigue – this list goes on. If you think Covid-19 is just a respiratory illness, think again.
With each week, it is becoming increasingly apparent that coronavirus can cause a number of neurological problems.
Several people who contacted me after a relatively mild illness talked about the ongoing cognitive impact of the disease – problems with their memory, fatigue, and focus.
But this is the more serious end that causes the most concern.
Speaking with Paul Milrea, it is hard to imagine that he had two massive strokes caused by coronavirus infection.
The 64-year-old, who is the director of communications at the University of Cambridge, is eloquent and, despite some weakness on the right side, is able-bodied.
He made one of the most remarkable recoveries ever seen by doctors at the National Hospital of Neurology and Neurosurgery (NHNN) in London.
His first stroke happened when he was in intensive care at a university college hospital. Potentially deadly blood clots were also found in his lungs and legs, so he took powerful blood-thinning (anticoagulant) drugs.
A couple of days later, he suffered a second, even greater stroke, and was immediately transferred to NHNN on Queen Queen.
Neurologist consultant Dr. Arvind Chandrateva was just leaving the hospital when an ambulance arrived.
“Paul had an empty expression,” he says. “He could see only on one side, and he could not understand how to use his phone or remember his password.
“I immediately thought that blood thinners caused bleeding in the brain, but what we saw was so strange and different.”
Paul suffered another acute stroke due to a clot, depriving vital parts of the brain of blood supply.
Tests showed that he had a surprisingly high level of blood coagulation marker, known as the D-dimer.
Usually they are less than 300, and in patients who have a stroke, it can grow up to 1000. The Paul Mylrea level was more than 80,000.
“I’ve never seen such a level of blood coagulability – something in his body’s response to the infection has made his blood incredibly sticky,” says Dr. Chandrateva.
During the blockage, the number of cases of emergency stroke decreased. But within two weeks, NHNN neurologists treated six Covid patients who had serious strokes. They were not associated with common risk factors for stroke, such as high blood pressure or diabetes. In each case, they saw very high levels of coagulation.
Part of the trigger for strikes was a massive overreaction by the immune system, which causes inflammation in the body and brain.
Dr. Chandratheva designed Paul’s brain images on the wall, highlighting large areas of damage shown as white spots affecting his vision, memory, coordination, and speech.
The stroke was so strong that the doctors thought that he most likely would not survive or remain disabled.
“After my second hit, my wife and daughters thought it was, they would never see me again,” Paul says. “The doctors told them that they can do little but wait. Then somehow I survived and became stronger. “
One of the first encouraging signs was Paul’s ability to speak languages — he speaks six — and he switched from English to Portuguese to speak with one of his nurses.
“Unusually, he learned several of his languages when he became an adult, and this created various wired connections in the brain that survived his stroke,” says Dr. Chandrateva.
Paul says he cannot read as fast as before, and sometimes forgets, but this is hardly surprising given the areas of damage in his brain.
His physical recovery was also impressive, which doctors attribute to his previous very high level of physical fitness.
“I used to ride a bicycle for an hour, worked out a couple of times a week in the gym and swam in the river. My days of cycling and diving are over, but I hope to return to swimming, ”says Paul.
Study in Lanceolate Psychiatry found complications from the brain in 125 seriously ill patients with coronavirus in British hospitals. Almost half of them suffered a stroke due to a blood clot, while others had inflammation of the brain, psychosis, or symptoms similar to dementia.
One of the authors of the report, Professor Tom Solomon from the University of Liverpool, told me: “Now it’s clear that this virus causes problems in the brain, whereas initially we thought that it was all about the lungs. Part due to the lack of oxygen enters the brain. But there seem to be many other factors, such as blood clotting problems and the hyperinflammatory response of the immune system. We must also ask if the virus itself infects the brain. ”
In Canada, neurologist professor Adrian Owen launched global online study of how the virus affects cognitionOwen said: “We already know that survivors in the intensive care unit are subject to cognitive impairment. Therefore, as the number of patients recovering with Covid-19 continues to increase, it is becoming increasingly clear that sending home from the intensive care unit is not the end for these people. just the beginning of their recovery. “
“Sars and Merce, both of which are caused by coronaviruses, were associated with some neurological diseases, but we had never seen anything like it before,” Dr. Michael Zandy, a neurologist at NHNN, told me. “The closest comparison is the 1918 flu pandemic. “We saw that over the next 10–20 years, many brain diseases and problems appeared.”
As a medical correspondent for the BBC, since 2004 I have been reporting global threats such as bird flu, swine flu, sars and Merc, both coronaviruses and Ebola. I have been waiting for most of my career for a global pandemic, and yet, when Covid-19 appeared, the world was not as ready as it could be. Unfortunately, we may have to live with the coronavirus endlessly. Here I will reflect on this new reality.
The mysterious neurological syndrome, known as lethargic encephalitis, appeared around the end of the First World War and continued to affect more than a million people worldwide. There is limited evidence of its causes and whether the trigger was an influenza or a post-infectious autoimmune disease.
In addition to a drowsy coma, some patients had motor disorders similar to Parkinson’s disease that affected them for the rest of their lives.
In his book Awakenings neurologist Oliver Sachs told the story of a group of patients who had been frozen in their sleep for decades, and how he used L-dopa to temporarily release them from a blocked state.
We must be careful before reading too many comparisons between Covid-19 and 1918 Spanish Flu PandemicBut with so many Covid patients having neurological symptoms, it will be important to look at the long-term effects on the brain.
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