india

Updated: Apr 18, 2020 20:00 IST

New Delhi: Coronavirus disease (Covid-19) can, in some instances, lead to disorientation or delirium, say neurologists treating Covid-19 patients. While the focus has so far been on the effect of the disease on the respiratory system, as doctors treat more patients, they are beginning to notice and document new patterns.

Neurologists are worried that some patients may be showing only neurological symptoms -- not other common symptoms such as fever and cough. If they are not monitored, diagnosis may be delayed. “Elderly patients with an infection, any infection including urinary tract infection can develop delirium. The general symptoms with fever could be confusion (delirium, encephalopathy). Loss of taste and smell are likely at the level of receptors in the mucosa,” said Dr Vivek Mathew, professor of neurology at Christian Medical College, Vellore which is treating Covid 19 patients.

A study published in the Journal of the American Medical Association on April 10 based on data collected from January 16 to February 19 at 3 Covid -19 care centres at Wuhan, China which included 214 hospitalised patients found that 36.4% showed neurological manifestations. Compared with patients with non-severe infection, patients with severe infection were older and had more underlying disorders. These patients showed fewer typical symptoms such as fever and cough but more neurologic symptoms.

Global trends seem to bear out the truth of those findings.

“In Covid-19, we have so far seen primarily respiratory symptoms or primarily gastrointestinal (GI) symptoms but in the past 10 days, cases of Guillain-Barré syndrome (GBS) (a condition in which a person’s immune system attacks the peripheral nerves) have been documented in other parts of the world ,” Mathew added.

Dr Col JD Mukherji, Principal Director and Head - Neurology at Max Super Speciality Hospital who is treating some Covid-19 patients says its still early days for India . “The general symptoms of the disease is headache, loss of smell and taste, fever, confusion. In China, cases of strokes, seizure and muscle injury have also been documented. We are on a learning curve in India. All of us will start seeing these cases as the numbers rise,” said Dr Mukherji.

He listed the four ways in which the virus can affect the brain: direct viral injury, causing symptoms like viral encephalitis; an excessive immune response called cytokine storm which can damage the brain; unintended host-immune response where the immune response damages some other structure altogether “like the five cases of Guillain-Barré syndrome (GBS) (a condition in which a person’s immune system attacks the peripheral nerves) documented in Italy”; and indirectly, “in those whose immune response has been deliberately reduced through medication due to conditions such as myasthenia gravis (a neuro-muscular disease) or multiple sclerosis.”

“There are no medicines for these neurological symptoms yet. If the entire body is in a cytokine storm, a monoclonal antibody can be used but they are expensive and may not be made available widely. In an Indian setting some steroids can be used which needs to be studied and decided,” said Dr Shamsher Dwivedee, Chairman, PSRI Institute of Neurosciences.