Across specialties – a study on brain complications in COVID-19 patients

Across specialties – a study on brain complications in COVID-19 patients

5508 3672 Anna Stelling, PhD

Since December 2019, when clinicians first reported infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19), researchers have been trying to decipher the effects of the virus on the different parts of the body. Neurological complications have been reported since initial reports of the virus, but most publications regarding those were either case studies or small studies with less than ten patients. The few larger studies available were limited in specialty and by geography.1 Hence, Aravinthan Varatharaj (University Hospital Southampton, UK) and his colleagues started to comprehensively describe the effects of COVID-19 on the brain reported in a UK-wide surveillance study.1

Data collection across neurobiology specialties

The team set up an online network for physicians to report COVID-19 cases with brain complications, covering the areas of neurology, stroke, psychiatry, and intensive care. Clinicians reported events classified into cerebrovascular events, altered mental status, peripheral neurology, or other syndromes. Data were collected in April 2020 during an exponential phase of the pandemic. A total of 153 patients were entered into the system, all after hospitalisation due to severe COVID-19 infection.1

Cerebrovascular events most common 

Dr Varatharaj and his team found that 62% of registered patients presented with a cerebrovascular event, of which the most common was ischaemic stroke (74%). These events were mostly seen in patients above 60 years of age, likely linked to increased preliminary risk for such events in the older population. Additionally, a total of 31% of patients experienced an altered mental status, including 59% of patients with a psychiatric diagnosis and others suffering from encephalopathy (23%) or encephalitis (18%). The majority of patients with psychiatric conditions was classified as new diagnoses. In contrast to cerebrovascular events, effects on mental status were seen equally in all age groups. However, the researchers state that there could be a bias due to attribution to delirium in the older population, suggesting that their results warrant further investigation.1

The impact of the study

The study is the first cross-specialty investigation that defines and characterises neurological syndromes in hospitalised COVID-19 patients, and its findings point out the importance of interdisciplinary approaches in the COVID-19 era. Furthermore, the results provide a foundation for more investigations, including research in patients who are not hospitalised, deciphering the underlying mechanisms of reported syndromes, as well as long-term follow-up and research on the severity of complications. The authors state that their “findings should direct future research to establish the role of viral neurotropism, host immune responses, and genetic factors in the development of such complications so that clinical management strategies can be developed.”1

  1. Varatharaj A et al. Lancet Psychiat. 2020;0:1–8
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