Neurological experts have revealed that Covid-19 is associated with the neurological disorders in many ways. They say that common neurological disorders associated with Covid-19 are encephalopathy, seizures, stroke, Guillain Barre Syndrome, Parkinsonism and acute myoclonus/ataxia among others.
As Covid-19 is a hypercoagulable state, patients can suffer from stroke due to Covid-19 infection. These strokes can be of varied kinds –small vessel stroke, medium sized strokes, or even large vessels occlusions where patients may have a severe and devastating paralysis along with, or soon after, Covid infection.
Explains Dr Pankaj Agarwal, senior consultant, neurology, head, movement disorders clinic and in-charge, DBS Programme at Global Hospital, Mumbai, “A common neurological problem in Covid-infected patients is encephalopathy which is an acute dysfunction of overall brain function. This acute dysfunction can be secondary to the infection itself, but is often multi-factorial due to hypoxia, electrolyte imbalance, viremia, and other organ involvement.”
“Covid-19 can sometimes cause seizures, or fits, often as part of a general neurological dysfunction but also because of various reasons as outlined above for encephalopathy,” he further adds.
It is also well known that cranial nerve involvement especially olfactory nerve involvement with anosmia, loss of taste, smell, and flavor are quite common in Covid-19 patients as a result of isolated or combined cranial nerve palsies. Facial paresis or Bell’s palsy affecting half the face is another manifestation. In addition, the peripheral nervous system is also separately a potential target for direct or indirect involvement by Covid-19 infection.
“We know that there is a well-known association now of Covid-19 triggering immunity causing ‘GBS’ or Guillain Barre Syndrome. This is an acute immune-mediated destruction of peripheral nerves causing paralysis of limbs and breathing. These patients may present acutely to the emergency and then may worsen, and require treatment with immune-modulatory treatment such as IVIG or plasma exchange. Of course any virus can trigger the immune system and cause GBS; Covid-19 being one of them but the association of Covid-19 and GBS is now well known and well described in the latter half of 2020 from literature around the world,” Dr Agarwal further explains.
The other problem that can occur is acute movement disorders such as acute myoclonus. There have been several reports of Myoclonic jerks or multifocal myoclonus secondary and sometimes ataxia or imbalance in addition, and this could occur as part of acute Covid infection as well.
One more important aspect for patients suffering from chronic neurological problems such as Parkinson’s disease is that they may have an apparently sudden worsening of their Parkinson’s.
Covid-19 infection or any virus can temporarily worsen symptoms of Parkinsonism and this will require close attention followed by treatment as well. Patients with chronic immune-mediated neurological conditions such as multiple sclerosis, myasthenia and other disorders, especially those on immunosuppressive medication, can be at higher risk of Covid-19 infection because of the ongoing immunosuppression. In these cases, one has to be more aggressive in treating Covid-19 as their immune systems may not clear the virus as effectively.
Lastly, we have what is now being increasingly referred to as the long-Covid syndrome. The patient gets a Covid-19 infection and after that, he or she may have slower cognitive function and might become slow in mentation.
“Often people report that after Covid-19 even for several months they are unable to think or focus clearly and are ‘not quite there’, in addition they may have persistent fatigue. This has been referred to as a ‘Covid fog’; and refers to a fogging of one’s mental state which may sometimes be persistent even till several months after Covid infection. Researchers don’t really know why this may occur from the scientific standpoint but it might be because of the way in which the virus interacts with organ systems in general and also the individual immune response of one’s body and brain to the virus,” Dr Agarwal said.
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