Increase in delirium, rare brain inflammation and stroke linked to Covid-19

https://medicalxpress.com/news/2020-07-delirium-rare-brain-inflammation-linked.html

by graeme • 6 years ago

152 108 6 years ago

irjustin3• 6 years ago

I'll admit - I'm skeptical and think we should take this headline with a grain of salt.

There's plenty of reasons to fear COVID but is brain damage really any more reason to fear it than the standard fever? i.e. are people getting brain damage from COVID itself or as a result of uncontrolled fever?

43 cases and the lack of wider spread makes me want to see more data before trying to sound any alarm bells.

oillio2• 6 years ago

There has been reports of blood related complications with COVID infections; inflammation and blood clots. Anecdotal, but here is one case:

https://www.scmp.com/news/world/europe/article/3091949/coron...

And a Nature article with more information: https://www.nature.com/articles/d41586-020-01403-8

Obviously it is too soon to tell, but this may be more of the same. It is concerning because we expect a large number of people to be exposed to this virus. Even a small chance of long term damage ends up with a lot of cases with the numbers we are expecting.

Additionally, it may change the calculus of so called herd immunity strategies. Though it is a little late for that.

__blockcipher__• 6 years ago

FWIW, blood clotting, strokes, etc are known complications of pathological cytokine release syndrome, and we see these same symptoms occurring in other diseases like Influenza.

Unfortunately there is a huge faction of people who seek to selectively represent facts to promulgate the narrative that SARS-CoV-2 is unusually dangerous, which as far as I can tell is just completely false.

SARS-2 is a great spreader and a very poor killer. Those interested in learning about hoe it spreads might find some of the research findings around interferon-mediated early course immunosuppression interesting. IMO it is a plausible mechanism for why SARS-2 exhibits PRE-symptomatic spread (not asymptomatic).

BTW the above (great spreader, with outcomes overwhelmingly positive) is precisely why I think SARS-2 was the worst possible candidate to respond to with a “lockdown”. It really saddens me to see destructive and unethical measures paraded as “common sense”, when they’re anything but. [/rant]

gnusty_gnurc2• 6 years ago

I feel like there’s a weird god of the gaps element to covid harm. Instead of recognizing that seemingly an overwhelming majority of people are fine and don’t suffer much adverse effects if any, there’s this automatic dwelling on extremely low probability extreme “invisible damage”. I’m increasingly convinced people are unsettled by the possibility that this could be anything other than civilization ending and the mask averse amongst us aren’t murderers. The desire for moral condemnation is too strong.

badRNG• 6 years ago

I’m increasingly convinced people are unsettled by the possibility that this could be anything other than civilization ending and the mask averse amongst us aren’t murderers.

In just the past couple of months, COVID-19 has racked up a body count of 130,000 dead Americans. For perspective, that's forty-five 9/11s worth of dead people. Asking people to wear a mask in public to curtail the spread saves lives. This has nothing to do with "desiring moral condemnation." The "mask adverse" can likely bear the burden of at least 1/45 of the deaths America has had compared to it's less "mask adverse" peers.

I absolutely hate wearing a mask, I'm "mask adverse" like yourself, but I wear one since this is a trolley problem where pulling the lever means I have to be uncomfortable for a few hours.

JoshTriplett• 6 years ago

the mask averse amongst us

"mask averse"? Really? We're talking about people who knowingly risk the lives of others; that's not their risk to take. Even without all the potential complications we're still discovering in survivors, we already know it kills people at a high rate.

I wouldn't go as far as "murder" unless someone actually knowingly had the disease and spread it to others, but "criminally negligent" would not be even slightly unwarranted. You don't point a gun at other people and pull the trigger just because you don't think there's a bullet in it.

It's not always easy to visualize "small probability of large harm", but the longer people keep fighting against steps like wearing a mask or not going out, the longer and more serious this will become, and the more people will die. "mask averse" is one of the major differences between places that have this more-or-less under control for the moment and places that don't.

There is no valid excuse to be anywhere around other people without some form of mask right now. None whatsoever. (Better yet, keep staying home if you possibly can, but that there are certainly some legitimate reasons to not do.)

Arguing against mask is like arguing you should be able to go without vaccination (which people do, but that is rightfully treated as conspiracy-theory-level harmful misinformation) or blow secondhand smoke in people's faces (except with a higher degree of potential harm from short-term exposure).

cameldrv3• 6 years ago

I can see someone being lockdown averse. Having to stay home all the time is a real drag. IMO it was (and is in many places) necessary, but what's the big deal with wearing a mask? Suppose COVID turns out to be nothing, what have you really lost by wearing a mask for a few months? Heck, if you have some phobia, wear a face shield.

coding123• 6 years ago

The pandemic could be over if 100% of the population wears them for just 2 months. That's a way better deal than what the mask averse are going to give us which is 12-15months and probably a few million more US lives over that timespan.

samcodes• 6 years ago

the mask averse amongst us

Oh can we coin a term like this for drunk driving? You know, when it’s more convenient to drive home drunk than leave your car out? That’s just being taxi-averse

nradov• 6 years ago

I doubt that SARS-CoV-2 is unique in this regard. A lot of people have neurological problems with no clear root cause. My hypothesis is that many of those cases were caused by viral infections. But we've never really looked.

zzleeper• 6 years ago

I recall reading about similar things in papers on the 1918 pandemic as well as SARS and other respiratory diseases. So it's not that far fetched off

Enginerrrd• 6 years ago

Well there are definitely hints of some level of neurologic involvement: loss of taste and smell, very strange presentation where people with low O2 sats aren't in respiratory distress (CNS depression?), and occasional reports of confirmed encephalopathy. SARS and MERS also have shown an ability to be neuroinvasive.

I'd be more skeptical of a claim that it for sure DOESN'T have neurologic involvement.

jaekash5• 6 years ago

loss of taste and smell

Not necessarily neurological and this is the first I heard that the loss of smell is neurological as opposed to physical[1]. But I guess everybody is a doctor now so go right ahead and say anything you like without any evidence. I mean what is the worse that could happen by spreading misinformation as long as it makes people more afraid?

[1] https://www.scientificamerican.com/article/why-covid-19-make...

beagle3• 6 years ago

O2 sats aren't in respiratory distress

It's important to note that low O2 doesn't cause a feeling of respiratory distress -- which is why carbon monoxide is so dangerous and why we have carbon monoxide detectors.

What does cause the feeling of respiratory distress, is CO2 buildup. We are used to having low O2 and high CO2 happen together (This correlation is likely why we evolved to detect low O2 through high CO2). Usually respiratory diseases impair both O2 intake and CO2 removal.

What's unusual about SARS-Cov-2 in this regard, is that it impairs O2 intake without harming CO2 removal - and it is unusual when compared to the vast majority of respiratory diseases, but also occurs in e.g. altitude sickness. To the best of my understanding, it has nothing to do with CNS depression in either SARSCov2 or altitude sickness.

irjustin3• 6 years ago

Not saying it's "not neurological" it's more about first order vs second order effects.

Loss of taste and smell are most likely first order effect - a direct result of COVID. You can't avoid this w/o avoiding

My guess (just a guess) for the article is the brain damage is a result of uncontrolled fevers - a second order effect. So if you control the fever, you can avoid the serious brain damage.

To that end, let's not be like OH NO BRAIN DAMAGE COVID screams. That's just not intelligent.

Animats• 6 years ago

This tells doctors what to look for. ADEM is treatable, so if someone has this complication, it's important to detect it.

Alex3917• 6 years ago

i.e. are people getting brain damage from COVID itself or as a result of uncontrolled fever?

Covid kills lung and blood vessel cells by depleting their ACE2 receptors. So if you develop a fever as one of your Covid symptoms, whatever inflammation is caused by that may well be only a small fraction of the total inflammation caused by the disease.

fovc• 6 years ago

Much more detail and link to original paper through here: https://medicalxpress.com/news/2020-07-delirium-rare-brain-i...

mirimir• 6 years ago

Thanks. That ought to be TFA's URL.

Paper: https://sci-hub.st/http://dx.doi.org/10.1093/brain/awaa240

dang• 6 years ago

Ok, we've changed to that from https://montrealgazette.com/news/world/scientists-warn-of-po.... Thanks!

graeme• 6 years ago

Thanks! (I did the original submission)

ghastmaster4• 6 years ago

Given that the disease has only been around for a matter of months, we might not yet know what long-term damage COVID-19 can cause

Statements like this, are quite disingenuous, especially when taken out of context. Using qualifiers like "Might" and "can" in the same sentence is par for the course for the propaganda I have seen over the past few months. Headlines and reports are repleat with what ifs and every sci-fi pathogen trope you can read.

Coronaviruses are not new to science. Pick any pathogen and take the rare cases of odd symptoms and spread it on every network. See how the public reacts.

Give me science! Few if any of our politicians are going on stage talking up the need for randomized studies. They scare us and we panic.

Darkphibre• 6 years ago

There is a LOT of anecdotal evidence COVID affects the neural system (it's even been found there during autopsies). The challenge for scientists is they need to raise the concerns during emergencies before the final 99.999% confidence 3-year double-blind studies are completed.

So they couch their terms in language that allows for understanding the lack of absolutes.

ghastmaster4• 6 years ago

As an example, one of the patients had a fever for 14 days and began doing odd things. This is not new or unique to covid.

Long fever alone causes a whole host of problems.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944485/

Neurological and cognitive dysfunction may occur acutely after an episode of hyperthermia and may lead to chronic damage, reported to occur in 50 % of survivors discharged from an ICU after heatstroke [87]. The pathophysiological mechanisms are presumed to be similar to those described above, but, in addition, the integrity of the BBB is disrupted allowing translocation of systemic toxins to enter the cerebral circulation. If neurological symptoms fail to improve after the acute episode, cerebellar dysfunction predominates. This is thought to be a result of the sensitivity of the Purkinje cells to thermal damage.

oillio2• 6 years ago

A nature article with 7 references from medical journals scientific enough for you?

https://www.nature.com/articles/d41586-020-01403-8

It is still too early for conclusive statements. However, it looks like there is more to this than fear mongering.

ghastmaster4• 6 years ago

Are we talking about the article posted or the research it refers to?

s1artibartfast2• 6 years ago

Classification as fear mongering should depend on the frequency and harm caused.

I tend to think that the reporting on these complications focuses on the fact that it can happen, without sufficient detail on how often, and how bad it is, and how often it happens in the absence of Covid-19. This information is necessary to inform people of how concerned they should be. Without it, readers are left up to their imagination.

If covid has a 0.X% infection fatality rate, and a 0.0X% chance of a less severe complication, how much more concerned should the public be?

autoexec2• 6 years ago

Give me science!

This is science. It's a review of the clinical data currently available and discussion of the findings as they relate to neurological damage. This isn't an attempt to scare you, it's preliminary steps to understand a new virus. Coronaviruses aren't new, but this one is and there's still much to be understood about how it's spread, what effects it has on the body, and how it can be treated.

Normally this information wouldn't get this kind of exposure, but since we're in the middle of a global pandemic which has caused hundreds of thousands of deaths in just a few months data is being shared as quickly and as widely as possible. This paper is nothing but a review of what's already being observed in some people who've been infected and a recommendation for additional research in this area all of which appears be entirely appropriate.

It's not at all disingenuous to caution that the long term damage done by this new virus is unknown. Science isn't about guess work and assumptions, it's about the careful collection and analysis of data and right now we don't have any because not enough time has passed.

ghastmaster4• 6 years ago

This is a news article with subjectively selected excerpts. My comment is regarding this.

0x8BADF00D• 6 years ago

This is a much more sensationalist piece than it ought to be. When a patient has a stroke, they will obviously develop brain damage. That is the definition of a stroke - a cerebrovascular accident. The title should be "brain injury causes brain damage".

GaryNumanVevo• 6 years ago

How is it sensational? The linked medical paper [see other parent comment] shows a link between COVID and brain inflammation, stroke, etc.

spaced-out2• 6 years ago

Comments like the one you responded to are what some people do to cope with all this.

Godel_unicode2• 6 years ago

That proposed title subtly promotes the "covid isn't that bad" theory by hiding some of its worse outcomes. I can't do anything about the proximal cause, I can however protect against the distal.

jurschreuder• 6 years ago

Isn't this just the man on the deserted island losing his grip, talking to a volleyball and having delirium / psychotic symptoms? A symptom of lockdown, side effect of the preventive treatment.

Wikipedia:

Solitary confinement has received severe criticism for having detrimental psychological effects[2] and, to some and in some cases, constituting torture.[3] According to a 2017 review study, "a robust scientific literature has established the negative psychological effects of solitary confinement", leading to "an emerging consensus among correctional as well as professional, mental health, legal, and human rights organizations to drastically limit the use of solitary confinement."[4]

"Psychological effects can include anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis."[21]

throwanem• 6 years ago

You don't get encephalitis from being lonely.

Fjolsvith6• 6 years ago

"Dr. Raji said, "Gray matter volume is a key marker of brain health. Larger gray matter volume means a healthier brain. Shrinking volume is seen in Alzheimer's disease. Gray matter includes neurons that function in cognition and higher order cognitive processes. The areas of the brain that benefited from an active lifestyle are the ones that consume the most energy and are very sensitive to damage." [1]

But you can experience bad brain health from inactivity.

1. https://www.psychologytoday.com/us/blog/the-athletes-way/201...

bE9a3S5So8igd3• 6 years ago

Not counter-narrative. Not-flagged

onetimemanytime• 6 years ago

In other words, try not to catch this thing before vaccines or treatments are here. Not one infected person has praised it, AFAIK.

Strokes, heart attacks, thrombosis, kidney failure, lung problems (possibly for life,) nervous system issues, brain damage...what else is left?

zwily• 6 years ago

Why would an infected person ever praise a virus?

dstola• 6 years ago

a detailed account of neurological symptoms of 43 people

The sample size is extremely small, and there is already selection bias because of pre-screening for neurological symptoms

who had either confirmed or suspected Covid-19

really, they couldn't test the 43 people for covid that they were doing a study on?

Increase in delirium, rare brain inflammation and stroke linked to Covid-19

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