Gurugram: Neuro issues in Covid patients worry doctors

Almost a month ago, a 28-year-old man, a resident of South City 1 was admitted in a multispecialty hospital of the city after he suffered seizures and fell unconscious.

Almost a month ago, a 28-year-old man, a resident of South City 1 was admitted in a multispecialty hospital of the city after he suffered seizures and fell unconscious. Although asymptomatic, he tested positive for Covid-19.

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“Out of the 200 Covid-19 patients treated so far, over 10 people developed neurological symptoms out of which four did not show the (most common) onset of Covid-19 like symptoms like breathlessness,” said Dr. Praveen Gupta, director, neurology, Fortis Memorial Research Institute (FMRI), Gurugram. “They report of unconsciousness and weakness due to brain inflammation or encephalitis. A couple of them even presented stroke and seizures too.”

Despite the cases of neurological symptoms, respiratory distress remains the defining symptoms of Covid-19, along with loss of sense of taste and smell.

When the 28-year-old reached the emergency of Fortis in a comatose state, he tested positive for Covid-19 twice. “The patient underwent MRI scan of his brain which came normal. His seizures stopped and after a day he regained consciousness. He was on ventilator for three days,” said Dr Gupta. “The patient developed a fever, had decreased oxygenation levels and a cough which persisted for a week. His sputum had blood.”

The patient was treated for his symptoms and discharged after he recovered and his Covid-19 confirmatory test returned negative.

A review of over 50 studies published in the journal Annals of Neurology last month revealed that the virus affects almost every level of the nervous system and may lead to strokes, seizures and muscular pains. However, the number of cases in India that presented neurological symptoms first were still far too few.

According to Dr. Gupta, the coronavirus can reach the brain through nasal passage and creates neurochemical imbalance. “The virus can bind with receptors in brain and blood vessels, and reach the central nervous system, causing inflammation and neurochemical imbalance, and ultimately leading to seizures,” he said.

Doctors explain that one of the pathological explanation for this is the formation of clots in blood vessels.

Dr. Yatin Mehta, chairman, critical care, Medanta Hospital, said, “The virus creates clots in different parts of the body, which, when it reaches the brain, can cause strokes and seizures.”

Mehta has treated Covid-19 patients who had symptoms like altered consciousness or mild paralysis. “We have seen neurological disorders in nearly 5% of the patients admitted in our hospital. They are mostly elderly and have to be kept on ventilator support. Fatality is also being reported due to stroke,” said Mehta.

Dr Gupta said that at least two Covid-19 patients in their hospital died of brain stroke. “There can be post viral immune mediated phenomena like ADEM (Acute Disseminated Encephalomyelitis – it is a rare inflammatory demyelinating disease of the central nervous system,” said Gupta. According to them, loss of taste and smell are initial symptoms.

Doctors said that patients with neurological symptoms sometimes recover in 15 days, while it is only rare cases treatment stretches up to a month and even death. Therefore, they suggest being cautious if there are signs of weakness and mild sensations in hands.

On June 14, while reviewing the study in the Annals of Neurology, Dr. Rajinder K Dhamija, head of the neurology department at the Lady Hardinge Medical College & Hospital in Delhi, had said, “There is literature to show that Covid-19 is beyond cough and fever. We should proactively probe the history of the patient.”