Even Moderate COVID-19 Cases Can Cause Serious Neurological Problems

By Jonathan Springston, Editor, Relias Media

Patients who contracted COVID-19 but did not need serious medical attention still exhibited signs of various neurological problems, as detailed in a paper published this week.

Through record reviews, investigators identified 74 patients who tested positive for COVID-19 and who were evaluated for neurological conditions at a large safety-net hospital in Boston between April 15 and July 1, 2020. The average age was 64 years (57% men, 51% African American). Of 74 patients, researchers discovered 47 with a history of neurological disease.

Common self-reported neurological issues were altered mental status, fatigue, and headache. At the time of hospitalization, some patients suffered seizures and strokes; others experienced movement disorders, such as myoclonus. Three patients sustained traumatic brain injuries caused by falling at home after developing COVID-19. One patient even showed signs of autoimmune encephalitis.

After reading about those events, one may believe these patients were seriously ill with COVID-19. But as study author Pria Anand, MD, noted, “the majority of these people did not require critical care [for COVID-19], suggesting that neurologic complications may be common in people with moderate COVID-19 as well as those with severe disease.”

For many in this cohort, the journey to recovery is just starting. There were 20 patients who went to skilled nursing facilities, 11 of whom had been living independently at home. Another nine patients landed in acute rehabilitation centers, eight of whom had been living at home. Three entered long-term acute care facilities, and five went to hospice.

Although the cohort was diverse in its racial and economic makeup, it still was small (and all were from one facility). Certain patients with neurological complications were neither evaluated by or admitted to neurology or neurocritical care services, leaving them out of this study.

“Our study did not include enough people overall and enough people affected by each neurologic condition to assess any relationships between factors such as race and ethnicity, healthcare access and housing, and people’s neurologic outcomes,” Anand said. “We plan to conduct additional studies to help determine what factors may either predispose people to neurologic complications or protect them from these complications, with the goal of using the results to help identify people at highest risk and look for prevention methods.”

Since the pandemic began, researchers have been observing the cascade of secondary health problems COVID-19 can trigger. The August issue of Neurology Alert includes an article about how the viral infection increases stroke risk by almost eight times the stroke risk with influenza.

More recently, in the November issue of Neurology Alert, author Jai Perumal, MD, wrote about the risks associated with immunosuppressive treatment for conditions like multiple sclerosis and the severity of complications from it.

“It is vital that one assess the risks vs. benefits individually and carefully before starting and/or continuing a DMT [disease-modifying therapy],” Perumal wrote. “For patients on immune-suppressive treatment, we must educate them about COVID-19 infections and emphasize that they follow all measures diligently to decrease the risk of potential exposure to COVID-19.”

For more Relias Media coverage of the COVID-19 pandemic, please click here.