‘Concerning increase’ of coronavirus-related inflammatory brain condition, study finds

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The widespread effects of COVID-19 include neurological disorders, and one study recently found that a fatal, inflammatory brain condition is increasing in prevalence due to the pandemic.

The condition, called acute disseminated encephalomyelitis (ADEM), is rare, mostly affects children and is triggered by viral infections. A team of researchers from University College London usually sees about one adult patient with ADEM per month, but that rose to at least one per week during the study period, which researchers said is a “concerning increase.”

The experts said the higher-than-expected number of patients with neurological disorders did not always correlate with the severity of respiratory symptoms. The study was published Wednesday in the journal Brain.

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"We should be vigilant and look out for these complications in people who have had COVID-19," said Dr. Michael Zandi, joint senior author, in a university news release. "Whether we will see an epidemic on a large scale of brain damage linked to the pandemic — perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic — remains to be seen.”

Early recognition of neurological diseases linked to COVID-19 is challenging because imaging is usually only done when a patient is slow to wake after prolonged ventilation, the study authors wrote.

The study offered a detailed account of 43 patients with neurological symptoms, with confirmed or suspected coronavirus infections, who were treated at the National Hospital for Neurology and Neurosurgery, Queen Square. The patients presented a wide range of neuroinflammatory disease.

Some patients had confusion and disorientation, while others had psychosis and seizures. Researchers identified 10 cases of “temporary brain dysfunction” with delirium, 12 cases of brain inflammation, eight cases of strokes and another eight cases with nerve damage.

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One 55-year-old patient with no previous psychiatric history showed ritualistic behavior after hospital discharge, such as putting her coat on and taking it off repeatedly. She also reported hallucinations, including seeing lions and monkeys in her house.

Researchers suggest the various neurological syndromes could be due to a hyperinflammatory bodily response, or that patients could be experiencing the effects of a severe systemic disorder with neurological consequences of sepsis, hypoxia and other critical illnesses. “Evidence of direct viral infection has proved elusive so far with only a few cases of SARS-CoV-2 in cerebrospinal fluid (CSF) reported,” they wrote in the study.

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The study's authors said the neurological complications associated with SARS-CoV-2 have similarities to other coronaviruses, such as severe acute respiratory syndrome (SARS) and Middle East acute respiratory syndrome (MERS). However, in those instances, the overall numbers of infected individuals were far less.

Further research is needed to determine the underlying pathobiological mechanisms, which will guide treatment, the experts said.

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