Medical experts suspect COVID-19 coronavirus capable of harming the brain

Symptoms ranging from feeling lethargic and confused to more serious ailments, such as seizures, strokes and encephalitis have been observed in the United States and abroad.

Doctors are pretty sure the symptoms are either a direct result of the coronavirus, or a side effect of the virus working on other systems, but more research is needed to know conclusively.

“It’s just too new,” Dr. Lin Mei, director of the Cleveland Brain Health Initiative, a consortium of 500 medical professionals involved in brain research, told cleveland.com this week.

But concerns about the links between COVID-19 coronavirus and brain ailments are high enough that the Centers for Disease Control and Prevention list “new confusion or inability to arouse” as an emergency symptom that should prompt immediate medical attention.

What’s known?

A coronavirus can spread through the body several ways, Mei said. It may migrate through a narrow line of protective cells between the nasal cavity and the brain. Or it can circulate through the body if it gets into the bloodstream. And sometimes, the virus attaches itself to nerve terminals.

“Those nerves … transport the virus into the brain,” Mei said. “Every nerve comes out of a unique region of the brain.”

What’s not known, though, is exactly how COVID-19 interacts with the brain – whether directly or by affecting other systems in the body that affect the brain – and the extent of the damage it can do.

Is the virus capable of prompting a stroke, or is it driving up blood pressure that leads to a stroke?

Research to answer those questions likely will take some time, perhaps longer than this coronavirus outbreak lasts, said Mei, who chairs the department of neurosciences at Case Western Reserve University’s School of Medicine.

But a case of encephalitis in Detroit reported last week in the Journal of Radiology and some previous cases in the United States and overseas have medical experts concerned.

In Detroit, a 58-year-old woman who tested positive for the coronavirus developed a case of acute necrotizing encephalitis, or ANE, a central nervous infection that mostly afflicts young children.

It is believed to be the first published case highlighting the association between encephalitis and COVID-19, doctors at the Henry Ford Health System said.

“This is significant for all providers to be aware of and looking out for in patients who present with an altered level of consciousness,” Dr. Elissa Fory, a Henry Ford neurologist, said in a news release. “We need to be thinking of how we’re going to incorporate patients with severe neurological disease into our treatment paradigm. This complication is as devastating as severe lung disease.”

Have there been other cases?

Yes.

In a case from Boca Raton, Florida, family members took a 74-year-old man who was feverish and short of breath to the hospital in early March, The New York Times reported. The man could not tell doctors his name or explain what was wrong. He had lost the ability to speak, was flailing his arms and legs and appeared to be having a seizure. The man tested positive for COVID-19 coronavirus.

Two recent studies suggest that patients with more severe cases are more likely to have brain ailments.

One, made available in February but not yet peer reviewed, found that 45% of patients with more severe cases of COVID-19 displayed neurologic symptoms such as acute cerebrovascular diseases and consciousness impairment.

The second, published in The BMJ in March, found disorders of consciousness were present in 22% of the diseased patients it studied, versus just 1% of recovered patients.

Both studies involved coronavirus cases from the Wuhan province of China.

Do other coronaviruses affect the brain?

Yes.

A connection between coronaviruses – a group of viruses ranging from the common cold to SARS and COVID-19 — and brain ailments would not be new.

“People have known about this for a number of years,” Mei said. “No doubt, for other coronaviruses, the virus can be detected in the brain and neurons can be altered.”

Indeed, a study from 2000 published in the American Society for Microbiology’s Journal of Virology noted evidence of human coronavirus in human brain autopsy samples and a possible association with multiple sclerosis. That study urged more research.

Separate studies published in 2004 and 2005 examined the spread of coronavirus through the body among patients with severe acute respiratory syndrome, better known as SARS. Each of those studies found that coronavirus invading several organs, including the brain.

What is needed now?

More information, according to Dr. Sherry H-Y. Chou, a neurologist at the University of Pittsburgh School of Medicine.

“We absolutely need to have an information-finding mission, otherwise we’re flying blind,” Chou told The New York Times. “There’s no ventilator for the brain. If the lungs are broken, we can put the patient on a ventilator and hope for recovery. We don’t have that luxury with the brain.”