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HomeCoronavirusCOVID-19 causes neurological injuries in 1 in 7 patients — NYU study

COVID-19 causes neurological injuries in 1 in 7 patients — NYU study

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 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%), researchers say. Such adverse effects also raise a coronavirus patient's likelihood (by 28%) 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 Dr Jennifer Frontera. "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.

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 10 March and 20 May, 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 centres to assist with the expectant surge of COVID-19 patients.

Early reports from Asia and Europe, where infections had spiked before rising in the US, 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%) and white (63%). 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 Dr Steven Galetta.

Galetta, the Philip K Moskowitz, 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.

Abstract
Objective: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among COVID-19 patients, we prospectively followed hospitalized SARS-Cov-2 positive patients and recorded new neurologic disorders and hospital outcomes.
Methods: We conducted a prospective, multi-center, observational study of consecutive hospitalized adults in the NYC metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between COVID-19 patients with and without neurologic disorders.
Results: Of 4,491 COVID-19 patients hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were: toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis, or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were RT-PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all P<0.05). After adjusting for age, sex, SOFA-scores, intubation, past history, medical complications, medications and comfort-care-status, COVID-19 patients with neurologic disorders had increased risk of in-hospital mortality (Hazard Ratio[HR] 1.38, 95% CI 1.17-1.62, P<0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, P<0.001).
Conclusions: Neurologic disorders were detected in 13.5% of COVID-19 patients and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.

Authors
Jennifer A Frontera, Sakinah Sabadia, Rebecca Lalchan, Taolin Fang, Brent Flusty, Patricio Millar-Vernetti, Thomas Snyder, Stephen Berger, Dixon Yang, Andre Granger, Nicole Morgan, Palak Patel, Josef Gutman, Kara Melmed, Shashank Agarwal, Matthew Bokhari, Andres Andino, Eduard Valdes, Mirza Omari, Alexandra Kvernland, Kaitlyn Lillemoe, Sherry HY Chou, Molly McNett, Raimund Helbok, Shraddha Mainali, Ericka L Fink, Courtney Robertson, Michelle Schober, Jose I Suarez, Wendy Ziai, David Menon, Daniel Friedman, David Friedman, Manisha Holmes, Joshua Huang, Sujata Thawani, Jonathan Howard, Nada Abou-Fayssal, Penina Krieger, Ariane Lewis, Aaron S Lord, Ting Zhou, D Ethan Kahn, Barry M. Czeisler, Jose Torres, Shadi Yaghi, Koto Ishida, Erica Scher, Adam de Havenon, Dimitris Placantonakis, Mengling Liu, Thomas Wisniewski, Andrea B Troxel, Laura Balcer, Steven Galetta

 

[link url="https://nyulangone.org/news/covid-19-frequently-causes-neurological-injuries"]NYU Langone Health / NYU School of Medicine material[/link]

 

[link url="https://n.neurology.org/content/early/2020/10/05/WNL.0000000000010979"]Neurology abstract[/link]

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