In New York, doctors treating patients with the emerging coronavirus (Covid-19) are increasingly noticing that with fever, coughing and shortness of breath, other symptoms appear: some patients are so confused that they do not know where they are and what year.
The inability to determine location and time is sometimes associated with hypoxia in the blood, but in some patients the level of confusion appears disproportionate to the level of inflammation in the lungs.
This raises a question about the impact of the emerging corona virus on the brain and nervous system, says Jennifer Frontera, a neurologist at the University of Langon Hospital in Brooklyn.
Some studies began describing the phenomenon. In the Journal of the American Medical Association (Gamma), doctors reported last week that 36% of 214 Chinese patients had neurological symptoms ranging from loss of smell and nerve pain to seizures and strokes.
In the most prestigious American medical journal, The New England Journal of Medicine, French doctors in Strasbourg reported that more than half of the 58 ICU patients were confused or upset. Brain images revealed a possible inflammation.
S. said. Andrew Josephson, head of the Department of Neurology at the University of California, San Francisco, told AFP: “Everyone says it’s a breathing problem, but it also affects a very valuable thing for us which is the brain.”
“If you feel confused and have trouble thinking, these are good reasons to see a doctor … The old idea that we should only go when we are feeling very distressed is no longer correct,” he says.
Viruses and the brain
Virologists are not completely surprised by the ability of the SARS-Cove 2 virus to affect the brain and nervous system, as this association has been observed with other viruses, including HIV.
Michael Toledano, a neurologist at the Mayo Clinic in Minnesota, says viruses can affect the brain in two main ways. The first is by triggering an abnormal immune response called “cytokine storm”, which causes an inflammation of the brain called autoimmune encephalitis.
The second is through direct infection to the brain or the so-called viral encephalitis. The brain is protected by what is called the blood-brain barrier and its role is to prevent the penetration of harmful substances into it, but this barrier can be penetrated.
Some make the hypothesis that the nose can be the pathway that connects to the brain, because olfactory loss is common in a large number of Covid-19 patients. However, this has not been verified, and many patients who lose their sense of smell have no worrisome neurological problems.
The main course is actually the immune response via hyperthermia. To fully verify this, the virus must be detected in the CSF. This was done once by a 24-year-old Japanese and described his condition in the International Journal of Infectious Diseases.
The patient was suffering from confusion and seizures, and pictures of his brain showed inflammation. However, the efficacy of the test has not yet been confirmed and scientists remain cautious.
Follow up on research
To discover these puzzles, Jennifer Frontera, who teaches at New York University School of Medicine, is collaborating on an international research project aimed at setting uniform standards for data collection.
Her team has documented seizures in patients with Covid-19 who had never had it before the disease. The researchers also observed subtle brain hemorrhage described as a “new” type.
They also wanted to take a sample of cerebrospinal fluid from a fifty-year-old man who had severe inflammation of the white matter in the brain. However, taking such samples, such as MRI, is difficult to perform for patients who use a respirator. Since most of these patients die, researchers cannot have a complete idea of neurological damage.
On the other hand, those who survive will end up consulting neurologists.
“We are seeing a lot of patients in trouble,” Rohan Arora, a neurologist at Long Island Hospital, Jewish Forest Hills, told AFP. He adds that this means 40% of the virus survivors.
It is not known whether these disorders are permanent. Inserting the patient into the recovery room is itself confusing, especially because of the medications given to him.
But the neurologist notes that returning to normal for Covid-19 patients appears to be taking longer than those who have survived a heart attack or stroke.