In a recent review published on June 8, 2020 in the Journal of Alzheimer’s Disease, a three-stage classification of the impact of COVID-19 on the central nervous system was identified. The review recommends hospitalized patients with the virus undergo MRI to flag potential neurologic damage and inform post-discharge monitoring. The stages include:
- Viral damage is limited to epithelial cells of the nose and mouth
- Blood clots that form in the lungs may travel to the brain leading to stroke
- The virus crosses the blood-brain barrier and invades the brain
Dr. Majid Fotuhi, MD, PhD, medical director of NeuroGrow Brain Fitness Center, McLean, Virginia stated that patients with COVID-19 symptoms, such as shortness of breath, headache, or dizziness, may have neurological symptoms that, at the time of hospitalization, might not be noticed or prioritized or whose neurological symptoms may become apparent only after the are discharged.
Bottom line, hospitalized patients with COVID-19 should have a neurological evaluation and ideally a brain MRI before discharge. If there are abnormalities, they should follow up with a neurologist in 3-4 months. The reason? The virus DNA has such limited information and yet it can wreak havoc on our nervous system because it kicks off a potent defense system in our body that damages our nervous system.
During this stage, patients may experience smell or taste impairments but often recover without any interventions.
A robust immune response is activated by the virus leading to inflammation in the blood vessels, increased hypercoagulability factors and the formation of blood clots in cerebral arteries and veins. The patient may experience either large or small strokes. Additional stage 2 symptoms include fatigue, hemiplegia, sensory loss, double vision, tetraplegia (quadriplegia), aphasia (unable to communicate) or ataxia (impaired balance/coordination).
The cytokine storm in the blood vessels is so severe that it causes an “explosive inflammatory response” and penetrates the blood-brain barrier, leading to the entry of cytokines, blood components and viral particles into the brain parenchyma causing neuronal cell death and encephalitis. This stage can be characterized by seizures, confusion, delirium, coma, loss of consciousness or death.
Patients in stage 3 are more likely to have long-term consequences because there is evidence that the virus particles have actually penetrated the brain and may remain dormant for years. Studies have also shown a link between the viruses and the risk of multiple sclerosis or Parkinson’s disease even decades later. To read the entire article please click the link below: