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Brain abnormalities may be more common in serious COVID-19 cases than previously thought

Many experts have recently revealed that central nervous system symptoms, like headache, altered mental status, acute cerebrovascular disease and epilepsy are becoming common in COVID-19 patients with serious complications. @Shutterstock

Along with many other symptoms of the virus like rashes and muscle aches, experts saw that many patients exhibited neurological symptoms too.

COVID-19 symptoms are many and the most common ones are sore throat, fever and breathing difficulty. But as the global pandemic took hold across regions and countries, more symptoms kept showing up. Along with many other symptoms of the virus like rashes and muscle aches, experts saw that many patients exhibited neurological symptoms too. Acknowledging this, many scientists across the globe started studying the trend and found that this is indeed true. Many experts have recently revealed that central nervous system symptoms, like headache, altered mental status, acute cerebrovascular disease and epilepsy are becoming common in COVID-19 patients with serious complications.

A recent study at Istanbul University-Cerrahpasa showed that nearly 50 per cent of all COVID-19 patients, who were in the intensive care unit (ICU), had brain abnormalities on MRI scans. This was published in Radiology. According to researchers of this study, 6 per cent of the patients in ICU experience acute stroke. Another 15 per cent developed an altered state of mind. Experts suspect that cytokine storm may have played a role in this. They say that recent evidence underscores a relatively high percentage of central nervous system symptoms. This is especially true for patients with more severe respiratory symptoms.

What experts say

Out of a total of 235 patients who were receiving care in ICU, 50 or 21 per cent of them had neurological symptoms. Out of these, 27 had brain MRI done. Researchers saw that 12 or 44 per cent had acute neurological symptoms. Ten patients also exhibited cortical FLAIR signal abnormalities, including an increased cortical diffusion-weighted signal with corresponding low ADC values, subtle leptomeningeal development, and punctuate cortical blooming artifact. The abnormalities occurred in different areas of the brain like the frontal lobe, parietal lobe, occipital lobe, temporal lobe, insular cortex and cingulate gyrus. The main differential diagnosis for this group of abnormalities is the infectious or autoimmune encephalitis, seizure, hypoglycemia, and hypoxia which can be accompanied by cortical microhemorrhages and blood-brain barrier breakdown.

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Findings of the study

According to the researchers, "Certain viral and autoimmune encephalitis can have a specific pattern of involvement that is helpful to establish a differential list. However non-specific imaging pattern in our series hinders achieving a specific diagnosis based on MRI."

Cerebrospinal fluid samples (CSF) were collected in 5 out of 10 patients with cortical signal abnormalities. Four of them showed elevated protein levels, cell counts, glucal levels, IgG index, and albumin were normal; while RT-PCR for both herpes simplex virus and SARS-CoV-2, were negative.

A total of 15 cases did not show any COVID-19-related or acute intracranial findings during their MRI exam. Despite negative MRI images, two samples of CSF taken from this group showed elevated protein levels.

Underlying health conditions may also be a factor

According to researchers, some of these neurological symptoms may also be because of underlying health conditions like diabetes, prolonged ICU stays and respiratory distress with hypoxia episodes. These neurological symptoms are higher in patients with more severe respiratory complications.

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