COVID-19 frequently causes neurological injuries
NYU Langone Health / NYU School of Medicine
Without directly invading the brain or nerves, the virus responsible for COVID-19 causes potentially damaging neurological injuries in about one in seven infected, a new study shows.
These injuries range from temporary confusion due
to low body-oxygen levels, to stroke and seizures in the most serious cases,
say the study authors.
Led
by researchers at NYU Grossman School of Medicine, the study showed no cases of
brain or nerve inflammation (meningitis or encephalitis), indicating no
immediate invasion of these organs by the pandemic virus, SARS-CoV-2.
While this should reassure patients, the neurological complications of COVID-19 should be taken seriously because they dramatically raise a patient's risk of dying while still in hospital (by 38 percent), researchers say.
Such adverse
effects also raise a coronavirus patient's likelihood (by 28 percent) of
needing long-term or rehabilitation therapy immediately after their stay in
hospital.
"The results of our study showed no signs that the coronavirus directly attacks the nervous system," says study lead investigator Jennifer Frontera, MD.
"The neurological complications seen in COVID-19 are predominately the
secondary effects of being severely ill and suffering from low oxygen levels in
the body for prolonged periods of time," says Frontera, a professor in the
Department of Neurology at NYU Langone Health.
Published
in the journal Neurology online Oct. 5, the study closely
monitored the progress of 606 COVID-19 adult patients diagnosed with brain or
other nerve-related medical conditions at any of four NYU Langone hospitals in
New York City and Long Island between March 10 and May 20, when coronavirus
infections were at their peak in the region.
Frontera
says that ahead of the pandemic, dozens of NYU Langone neurologists and
trainees had deployed across its medical centers to assist with the expectant
surge of COVID-19 patients.
Early
reports from Asia and Europe, where infections had spiked before rising in the
United States, she says, had also "raised the alarm" about possible
brain damage from coronavirus infection. Because of this, the research team was
ready to look for any signs of neurological dysfunction among the thousands of
patients being admitted to hospital in the spring. Among all the hospitals,
4,491 patients tested positive for COVID-19 during that time.
Among
the study's other key results was that common neurological problems, such as
confusion caused by chemical electrolyte imbalances, severe infection or kidney
failure, usually arose within 48 hours of developing general COVID-19 symptoms,
including fever, difficulty breathing, and cough.
Half of those neurologically affected were over the age of 71, which researchers say is significantly older than the other 3,885 patients with COVID-19 (at a media age of 63) who did not experience brain dysfunction.
Most were men (66 percent)
and white (63 percent). Frontera notes that the study results do suggest that
Blacks are not at greater risk of neurological complications than other
COVID-19 patients, which is "welcome news," given that Blacks are
widely known to be at greater risk of death from coronavirus infection. However,
she says this potentially important observation requires further investigation.
While the coronavirus is known to attack other organs, including blood vessels and the heart, researchers say its main target is the lungs, where it makes breathing difficult, starving the body of oxygen it needs to stay alive.
Low
levels of oxygen in the body and brain was another common neurological problem,
study results showed, that could lead to confusion, coma, or permanent brain
damage.
"Our
study results suggest that physicians need to be more aggressive in stabilizing
body oxygen levels in patients with COVID-19 as a potentially key therapy for
stopping, preventing and/or possibly reversing neurological problems,"
says study senior investigator Steven Galetta, MD.
Galetta,
the Philip K. Moskowitz, MD Professor and chair of the Department of Neurology
at NYU Langone, says various blood-oxygen-raising therapies that could possibly
work against neurological problems in patients with COVID-19 include early
intubation or use of heart-lung machines, called ECMO, which mechanically
"clean" the blood and "deliver" oxygen into it.
Funding
support for the study was provided by National Institutes of Health grant P30
AG066512 and NYU Langone.