A S THE OUTBREAK OF A VIRULENT NEW DISEASE— “If this was like other viral infections, there would be fatigue, cognitive complaints, and the like,” says neurologist Ayush Batra of Northwestern University. Reports of related coronavirus infections—SARS and MERS—cited severe central nervous system (CNS) disease, including encephalitis and stroke. But the extent of Covid’s impact on the brain was striking. In a published retrospective study of 509 hospitalized patients, Batra and colleagues saw neurologic manifestations in 83 percent. These ranged from headaches and dizziness to strokes and seizures. A larger prospective study reported symptoms severe and pronounced enough to meet diagnostic criteria for neurological disorders in 13.5 percent of 4,491 patients hospitalized with laboratory-confirmed Covid-19. The most common of these disorders was encephalopathy, alterations in consciousness ranging from confusion and disorientation to coma. “A lot of Covid-19—spread relentlessly across continents, doctors were not entirely surprised to see neurological problems. oxygen levels and low blood pressure.” In some, prolonged hypoxia and hypotension led to brain damage verified by magnetic resonance imaging (MRI) or computerized tomography (CT) scans. Age and sex were factors: Those who developed neurological disorders were significantly older than those who did not, and more likely to be male. Comorbid disorders, such as hypertension, diabetes, and atrial fibrillation, were more common as well. Obesity did not play a role; in fact, “patients who had neurological damage had slightly lower BMI (body mass index) than those who did not,” says Frontera. It is unlikely that neurological disorders were the effects of treatment rather than disease in either study. “At that time [early in the pandemic], hydrochloroquine and azithromycin were the most commonly used medications, and [neurological events] are not known side effects [of these drugs],” Frontera says. Some hemorrhagic strokes (seen in 0.4 percent people came in because they were confused, and some developed it later in their hospital stay,” says Jennifer Frontera , professor of neurology at New York University (NYU) and lead author of the study. “It was often related to low
of patients in her series) may have been secondary to anticoagulation, however. Nearly two percent of the patients in Frontera’s group suffered strokes (the majority ischemic), confirming what had been reported elsewhere: A study of patients with PCR- confirmed Covid-19, who were hospitalized or treated in the emergency department of two NYC hospitals, found the risk of stroke to be 7.6-fold larger than with influenza. An unlikely proportion occurred in younger patients. One New York City hospital reported that five Covid-positive patients under 50 were admitted with strokes in a two-week period, seven times the rate for this age group the year before. Over the Long Haul “I had a fever and a bit of a cough, but I wasn’t that sick,” says Sarah Ehekircher of her bout of Covid-19 in August. “I’d feel really good for a couple of days and think I could come out of quarantine, and then I was sick again.” But ever since, the 52-year-old Seattle resident says, she has suffered from profound fatigue—“I can’t walk up a flight of stairs without having to stop”—and disturbing mental problems. “I have difficulty coming up with words. I constantly lose my train of thought. I can’t concentrate enough to read a book. I feel an overwhelming wash of brain fog, and I can’t function. “A couple of months ago, I literally thought I had dementia,” she continues. “I couldn’t figure out a bus schedule! I thought I’d need to have someone come in to help me.” Equally troubling has been the effect on her relationships. “I’d fire off hurtful text messages and ask myself, ‘why did I do that?’ It was like being a teenager with no impulse control. I didn’t recognize myself.” Ehekircher’s symptoms are typical of what many Covid patients experience. When one thinks the disease is over, all too often it’s not all over. “The acute infection doesn’t last very
long—you can’t detect it after a week or two,” says Avindra Nath , intramural clinical director of the National Institute for Neurologic Disorders and Stroke (NINDS). “The virus has gone, but the music lingers on.” Extreme fatigue, worsened by exercise,
“resembles to some degree chronic fatigue syndrome, which occurs after a viral infection. As soon as the pandemic started, we knew we were going to see these patients.”
“There’s been a lot of fantastic scientific work worldwide, and it’s been stunning to see the rate of progress… a heroic and unprecedented achievement.”
32 DANA FOUNDATION CEREBRUM | Spr ing 2021
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