COVID-19 Neuro problems
Posted On August 15, 2020
Smell & taste disorder
- common early symptom
- over 80% in one series
- MRI may show aignal abnormality in olfactory bulbs
- 2 autopsy cases showed inflammatory infiltrate olfactory tracts
- 44% recovered within 8 days in 1 series
Encephalopathy
- Could be from metabolic or hypoxic encephalopathy
- No evidence of brain inflammation by imaging and CSF study
- High levels of cytokines may cause confusion, altered Level of consciousness
- Seizures are reported
- MRI may show strokes,leptomeningeal abnormalities
Meningoencephalitis
- Rare
- could be viral or autoimmue
Strokes
- Stroke is infrequent: 0.4 to 2.7%
- tpa, mechanical thrombectomy can still be considered
- higher reocclusion rate has been reported
- Bleed: 0.3-0.9%
- covid-19 may cause hypercoagulability state: elevated D dimer, especially in severe cases
- myocarditis may cause embolic stroke
- atrial fibrillation, anticoagulation can be considered
Guillain-barre syndrome
- In 1 series: 5 in 1200 patients.
- CSF: minimal cells, but elevated protein
- MRI may show root enhancement
- May need ivig or plasmapharesis
Rhabdomyolysis
- 11% of patientsin Wuhan has cpk over 200
- Italy: 2 case report of CPK over 12000
Generalized myoclonus
- 3 patients reportd
- apparent post infectious complication
- treated with levetiracetam, valproate, clonazepam, propofol
PRES: posterior reversible encephalopathy syndrome
- reported in a few patients