Various media sources have warned of brain conditions including stroke and nerve damage in people with COVID-19. New research has begun to unravel the range and approximate frequency of these conditions so far.

UK doctors, for example, identified 43 patients hospitalised with COVID-19 infection during April to May who had neurological complications. This included 12 with inflammatory conditions of the brain and spinal cord, 10 with psychosis and 8 with stroke caused by a blood clot. There have been other global reports of stroke among patients hospitalised with COVID-19.

It was recognised early in the pandemic that COVID-19 may cause problems with blood clotting. Neurological symptoms such as headaches, loss of taste and smell are also among the range of known symptoms.

However, we don’t know how common stroke or serious neurological complications are, how they may be linked with the severity of infection or other underlying medical problems. Doctors are still trying to understand the full range of effects of COVID-19, during infection and after recovery.

Where did the story come from?

The Irish Times highlighted research published in the journal Brain which detailed the neurological complications observed among UK patients with COVID-19.

Other sources such as Healthline have focused on the stroke risk. They highlight case reports from the US, published in the New England Journal of Medicine (NEJM), which have observed unusual numbers of stroke patients who’ve tested positive for the infection.

What is the basis for the claim?

In the Brain publication, doctors identified 43 patients referred to a specialist COVID neurology and neurovascular team in London from the 9th April to 15th May 2020. Two-thirds had definite COVID-19 infection confirmed by viral test, and the remainder met World Health Organization (WHO) case definitions for definite probable or possible COVID-19. The patients ranged in age from 16 to 85 years, 56% male and 53% of non-white ethnicity.

The patients presented in 5 distinct diagnostic groups:

  • 12 had inflammatory conditions of the brain and central nervous system (encephalitis and myelitis) with signs of bleeding in several cases
  • 10 patients had some form of temporary brain disturbance (encephalopathy) associated with disordered thinking and confusion (delirium/psychosis), but no abnormalities on brain scans or lumbar puncture
  • 8 had ischaemic strokes caused by a blood clot, some of whom also had clots on the lungs
  • 8 had nerve problems (7 had Guillain-Barré syndrome, which is characterised by progressive paralysis starting in hands and feet)
  • 5 had a range of other conditions that didn’t fit into these categories

There didn’t seem to be any association with the severity of COVID respiratory symptoms.

In the US, doctors from New York City reported in a NEJM study of 5 patients aged less than 50 years who had presented with severe stroke during 2 weeks in March/April, all of whom tested positive for COVID-19. This was more than they would usually see in that period.

The association with stroke is consistent with the disordered blood clotting known to be associated with COVID-19.  Neurological effects are also among the range of recognised complications of viral infections. However, we will need to wait for population-based studies to know exactly how common severe neurological complications or stroke may be among people with COVID-19 infection.

David Strain, a senior clinical lecturer at the University of Exeter medical school, is quoted by the Irish Times saying that only a small number of patients appear to experience serious neurological complications.

What do trusted sources say?

The US Centers for Disease Control and Prevention stated that some patients with COVID-19 may develop signs of increased blood coagulation and be at risk of blood clots, including deep vein thrombosis, pulmonary embolism, heart attack and stroke. They state that the cause is unknown, but it could be that the inflammatory proteins released by the immune system in response to infection, affect the body’s blood clotting systems.

The CDC, WHO and other global resources list loss of taste or smell, headaches and general muscle aches and pains among the range of possible symptoms. WHO advises anyone with loss of speech or movement to seek immediate medical attention.

Analysis by EIU Healthcare, supported by Reckitt Benckiser

Citation

  1. Paterson RW et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020 Jul 8. https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408

Reading list

  1. Oxley TJ et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. New England Journal of Medicine. 2020 May 14;382(20):e60. https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=featured_home
  2. The US Centers for Disease Control and Prevention. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). Updated June 30 2020.
  3. World Health Organization. Q&A on coronaviruses (COVID-19). 17 April 2020.