Altered mental status and stroke are the most common neurological symptoms that hospitalized COVID-19 patients experience, according to a new study from Italy.
People with SARS-CoV-2, which is the virus that causes COVID-19, can experience a variety of symptoms.
According to the Centers for Disease Control and Prevention (CDC), these are usually physical symptoms, such as fever or chills, a cough, fatigue, and shortness of breath.
Among the warning signs that indicate that a person needs emergency medical care, the CDC list confusion and an inability to wake up or stay awake.
Although the neurological symptoms associated with COVID-19 have received much less attention than the physical symptoms, some studies suggest that they are common among people with severe forms of the illness.
A study in the BMJ, for example, found that among COVID-19 patients who died at a hospital in Wuhan, China, 22% had experienced a disorder of consciousness, compared with only 1% of those who recovered.
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Cluster headache, the medical term for the condition, is as common as but much less well known than other neurological disorders such as multiple sclerosis or Parkinson’s disease. One in 1,000 people have it. It involves excruciating pain that can last for anything between 15 minutes and three hours. It is known as “suicide headache” because 64% of sufferers think about taking their own life.
A preprint of another study of hospitalized patients in China found that overall, 25% had central nervous system symptoms or diseases. These included headaches, dizziness, impaired consciousness, uncoordinated muscle movements, seizures, and strokes.
These were more likely in those with severe disease. For example, 6% in the severe group had strokes, compared with 1% in the non-severe group.
In the first published study of its kind, researchers at the University of Cincinnati in Ohio and several Italian universities analyzed the findings of imaging investigations into hospitalized patients in Italy who experienced neurological symptoms with COVID-19.
The researchers have now published their results in the journal Radiology.
After China, Italy became the second epicenter of the COVID-19 pandemic. Italy has now had more than 33,000 deaths.
The researchers analyzed the records of patients treated at the University of Brescia, the University of Eastern Piedmont in Novara, and the University of Sassari.
Out of 725 patients, 15% experienced neurological symptoms or disease. Of this 15%, 99% underwent a CT scan.
The most common neurological symptoms were “altered mental state,” which 59% of the patients experienced, and ischemic strokes, which 31% of the patients experienced.
“Altered mental status” encompasses a wide range of possible signs and symptoms, including confusion, delirium, and coma.
Among the less common neurological symptoms were headache (12%), seizures (9%), and dizziness (4%).
Imaging revealed acute abnormalities in 47% of the patients. Among the most common findings were ischemic strokes, and in 6% of the patients, there were signs of intracranial hemorrhage.
“These newly discovered patterns could help doctors better and sooner recognize associations with COVID-19 and possibly provide earlier interventions,” says lead study author Dr. Abdelkader Mahammedi, an assistant professor of radiology at the University of Cincinnati.
The study was unable to shed light on whether or not SARS-CoV-2 directly damages the central nervous system. It might be that neurological symptoms are a side effect of critical illness. Lack of oxygen in the brain, for example, can cause confusion or loss of consciousness.
In addition, of the 108 patients, 71% had one or more preexisting chronic conditions. These included hypertension, diabetes, coronary artery disease, and cerebrovascular disease.
In their paper, the researchers cite accumulating evidence to suggest that some people with severe COVID-19 experience a “cytokine storm,” in which the body produces an excess of pro-inflammatory molecules called cytokines. This can cause blood clots, which can, in turn, trigger ischemic strokes.
“This topic definitely needs more research,” says Dr. Mahammedi.
“Currently,” he adds, “we have a poor understanding of the neurological symptoms in COVID-19 patients, whether these are arising from critical illness or from direct central nervous system invasion of SARS-CoV-2. We hope further study on this subject will help in uncovering clues and providing better interventions for patients.”