Study describes brain complications in patients with severe COVID-19

A study of 153 patients treated in hospitals in the United Kingdom during the acute phase of the novel coronavirus (COVID-19) pandemic describes a range of neurological and psychiatric complications that may be linked to the disease, according to a new study published in the journal The Lancet Psychiatry.

To investigate the breadth of COVID-19 complications that affect the brain, the researchers set up a secure, UK-wide online network for specialist doctors to report details of specific cases. These portals were hosted by professional bodies representing specialists in neurology, stroke, psychiatry, and intensive care. Data was collected between April 2 and April 26, 2020, during the exponential phase of the pandemic.

Of the 153 cases reported, full clinical details were available for 125 patients. The study included patients with confirmed COVID-19 infection by PCR test (114 people), probable infection as diagnosed from chest X-rays or CT scans (six people), and possible infection, where patients had symptoms consistent with disease but diagnostic tests were either negative or not done (five people).

The most common brain complication observed was stroke, which was reported in 77 of 125 patients. Of these, 57 patients had a stroke caused by a blood clot in the brain, known as an ischemic stroke, nine patients had a stroke caused by a brain hemorrhage, and one patient had a stroke caused by inflammation in the blood vessels of the brain. Age data was available for 74 of the patients who experienced a stroke and the majority were over 60 years of age.

Additionally, 39 patients showed signs of confusion or changes in behavior reflecting an altered mental state. Of these, nine patients had unspecified brain dysfunction, known as encephalopathy, and seven patients had inflammation of the brain, medically termed encephalitis. Long-term follow-up studies to assess duration and severity of these complications are needed.

The remaining 23 patients with an altered mental state were diagnosed with psychiatric conditions, of which the vast majority were determined as new diagnoses by the notifying psychiatrist. Although most psychiatric diagnoses were determined as new by the notifying psychiatrist or neuropsychiatrist, the researchers say they cannot exclude the possibility that these were undiagnosed before the patient developed COVID-19.

The 23 patients with psychiatric diagnoses included ten patients with a new-onset psychosis and six patients with a dementia-like syndrome. Seven patients had signs of a mood disorder, including depression and anxiety.

Age information was available for 37 of the 39 patients with an altered mental state and of those, around half were aged under 60 years of age.

The patients included in the study were selected for inclusion by expert doctors and therefore likely represent the most severe cases. It is not possible to draw conclusions about the total proportion of COVID-19 patients likely to be affected based on this study and, considering these findings further research is now needed, the authors said.

Researchers say their report offers a detailed snapshot of the breadth of neurological complications in COVID-19 patients and should help to direct future research to establish the mechanisms of such complications so that potential treatments can be developed.

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