Although respiratory distress is the predominant complication of COVID-19, there are also rare, yet serious, neurological ailments that may arise. A survey of UK hospitals found that some patients also experience strokes, dementia-like symptoms, and delirium. The findings were published on June 25 in The Lancet Psychiatry.
Throughout April, neurologists in the United Kingdom used databases to find 125 hospitalized patients who tested positive for COVID-19 and also experienced certain neurological afflictions. More than half of the patients suffered a cerebrovascular event, with 57 patients enduring an ischemic stroke, while nine had an intracerebral hemorrhage.
“These relatively rare but incredibly severe complications get missed, like needles in a haystack,” Benedict Michael, a neurologist at the University of Liverpool and senior author of the paper, tells Science News. “Now that we know the rough idea of the scale of this, we desperately need research that gets to the disease mechanisms.”
An altered mental state was the second most common neurological malady, with 39 patients experiencing new-onset psychosis, neurocognitive decline, or other conditions.
The patients from the survey ranged in age from 23–94. While patients of all ages were roughly equally likely to experience an altered mental state, those over age 60 were more than four times more likely to have a cerebrovascular event than their younger counterparts were.
“This actually is a direct effect, in some people, of the virus going into brains,” Mark George, a psychiatrist and neurologist at the Medical University of South Carolina who was not involved with the study, tells STAT.
It isn’t clear whether these symptoms of delirium are coming from the virus or if the hospital’s stressful conditions are at least partially to blame. The New York Times reports that some changes aimed to minimize the spread of SARS-CoV-2 in hospitals, such as little human contact from the use of head-to-toe protective equipment for healthcare workers and the lack of visitors, have made hospitalization more stressful than normal. On top of that, fighting the virus has its own inherent challenges, including decreased oxygen intake and cumbersome attachments to machines.
“It’s like the perfect storm to generate delirium, it really, really is,” delirium expert Sharon Inouye of the Hospital Life Elder Program tells the Times. The article recounts the case of a 31-year-old COVID-19 patient from Tennessee, not included in the survey, who experienced hospital delirium as a terrifying ordeal, hallucinating situations such as burning alive, being attacked by cats, and being experimented on in another country. Once, the visions were so vivid and scary that she ended up pulling out her ventilator tube.
Because the UK survey focused on hospitalized patients, it does not shed any light on how many people with COVID-19 might be experiencing milder neurological symptoms, such as fatigue, anxiety, or altered sensory perception. It is also unclear how long patients could expect to experience these symptoms.
“There’s increased risk for temporary or even permanent cognitive deficits,” psychiatrist Lawrence Kaplan tells the Times. “It is actually more devastating than people realize.”