COVID-19 and Lingering Neurological Problems

In early 2020, after the United States had its first reported case of COVID-19, Sherry Chou and a group of her fellow neurointensivists—critical care clinicians who have neurological expertise—became concerned that the novel coronavirus would affect the nervous system.

Chou said that history had taught them to be worried. Other infectious diseases, such as the 1918 influenza (an H1N1 virus), have affected multiple organ systems.

An associate professor of critical care medicine, neurology and neurosurgery at Pitt, Chou created and leads the Global Consortium Study of Neurologic Dysfunction in COVID-19. The largest cohort study of neurological manifestations of the coronavirus, it spans 133 adult and 109 pediatric study sites across six continents. Ericka Fink, associate professor of critical care medicine and pediatrics at Pitt, is the primary investigator on the pediatric arm of the study.

In May, the consortium published first results in its adult population study in JAMA Network Open that show eight out of 10 people hospitalized with COVID-19 develop neurological problems.

“We expected there’d be some, but that was a lot,” said Chou, associate director of Stroke and Subarachnoid Hemorrhage at the Pitt Safar Center for Resuscitation Research.

It gets scarier: Hospitalized patients with clinically diagnosed neurological symptoms associated with COVID-10 are six times more likely to die than those without.

The study consisted of 3,744 patients ages 18 and over, and the results were broken down by symptoms self-reported by the patient and also syndromes captured by clinicians. Nearly 40% self-reported having headaches; about 30% said they had lost their sense of smell or taste.

Chou said that acute encephalopathy, or damage to the brain, was the most common problem.

“These are people who are confused, who are delirious, who are not themselves,” she said. “They have altered sensorium, memory problems and about every other person hospitalized with COVID-19 had that condition.”

When the pandemic began, Chou said one of her greatest fears was that COVID-19 would directly attack the brain and cause meningitis and encephalitis (brain infection and inflammation). However, she said that has been rare, occurring in less than 1% of hospitalized COVID-19 patients.

Patients who had been diagnosed with a neurological condition prior to the pandemic—from chronic migraines, dementia or Alzheimer’s disease to spinal cord and nerve diseases—are more than twice as likely to develop a COVID-19-related neurological issue than those without this predictor, according to Chou.

The JAMA Network Open paper represents the first phase of the study. Chou said she hopes to answer more questions in the next phase, such as: How long do neurological symptoms last in COVID-19 patients, and how does this impact the patient long-term?

“And the key question is, ‘How do we treat it?’” she said.

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