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Severe Neurological Ailments Reported in COVID-19 Patients – The Scientist

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 2394. 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 isnt clear whether these symptoms of delirium are coming from the virus or if the hospitals 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.

Its 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.

Theres increased risk for temporary or even permanent cognitive deficits, psychiatrist Lawrence Kaplan tells the Times. It is actually more devastating than people realize.

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Duke Neurology congratulates the graduating residency class of 2020 | Duke Department of Neurology – Duke Department of Neurology

The Duke Neurology residency class of 2020 held their graduation virtually this week, celebrating the completion of their four years of training and contributions to our Department amidst departmental growth, a continuing global pandemic, and numerous other challenges.

Our graduating class of residents will complete their neurology training in fellowships across the field of neurology, both at Duke and in other leading academic institutions across the country.

Congratulations to you all. Youre an amazing class of residents and truly phenomenal doctors. Make yourselves proud of yourselves as we are of you, said Assistant Professor Shreyansh Shah, MD, who shared hosting duties for the graduation. Thanks for selecting us and letting Duke Neurology be a part of your training.

Our graduating residents have selected the following fellowship programs for next year:

The ceremony included a homemade blues song by Associate Professor Emeritus Marvin Rozear, MD, who has been a mainstay of the Neurology Residency program for four decades.

Graduation closed with the presentation of awards to faculty and residents, with winners selected by this years graduating class. Assistant Professor Scott Le, DO, received the 2020 Marvin Rozear Common Sense Award. Assistant Professor Scott Strine, DO, received the 2020 Eun-Lyu Lee Excellence in Teaching Award. Graduating resident Abhi Kapuria, MD, received both the E. Wayne Massey Teaching Award and the Chief Resident Research Award for 2020.

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Coronavirus: What does Covid-19 do to the brain? – BBC News

Image caption Consultant neurologist Arvind Chandratheva points out brain damage on a scan

Stroke, delirium, anxiety, confusion, fatigue - the list goes on. If you think Covid-19 is just a respiratory disease, think again.

As each week passes, it is becoming increasingly clear that coronavirus can trigger a huge range of neurological problems.

Several people who've contacted me after comparatively mild illness have spoken of the lingering cognitive impact of the disease - problems with their memory, tiredness, staying focused.

But it's at the more severe end that there is most concern.

Chatting to Paul Mylrea, it's hard to imagine that he had two massive strokes, both caused by coronavirus infection.

The 64-year-old, who is director of communications at Cambridge University, is eloquent and, despite some lingering weakness on his right side, able-bodied.

He has made one of the most remarkable recoveries ever seen by doctors at the National Hospital for Neurology and Neurosurgery (NHNN) in London.

His first stroke happened while he was in intensive care at University College Hospital. Potentially deadly blood clots were also found in his lungs and legs, so he was put on powerful blood-thinning (anticoagulant) drugs.

A couple of days later he suffered a second, even bigger stroke and was immediately transferred to the NHNN in Queen Square.

Consultant neurologist Dr Arvind Chandratheva was just leaving hospital when the ambulance arrived.

"Paul had a blank expression on his face," he says. "He could only see on one side and he couldn't figure out how to use his phone or remember his passcode.

"I immediately thought that the blood thinners had caused a bleed in the brain, but what we saw was so strange and different."

Paul had suffered another acute stroke due to a clot, depriving vital areas of the brain of blood supply.

Tests showed that he had astonishingly high levels of a marker for the amount of clotting in the blood known as D-dimer.

Normally these are less than 300, and in stroke patients can rise to 1,000. Paul Mylrea's levels were over 80,000.

"I've never seen that level of clotting before - something about his body's response to the infection had caused his blood to become incredibly sticky," says Dr Chandratheva.

During lockdown there was a fall in the number of emergency stroke admissions. But in the space of two weeks, neurologists at the NHNN treated six Covid patients who'd had major strokes. These were not linked to the usual risk factors for stroke such as high blood pressure or diabetes. In each case they saw very high levels of clotting.

Part of the trigger for the strokes was a massive overreaction by the immune system which causes inflammation in the body and brain.

Dr Chandratheva projected Paul's brain images on a wall, highlighting the large areas of damage, shown as white blurs, affecting his vision, memory, coordination, and speech.

The stroke was so big that doctors thought it likely he would not survive, or be left hugely disabled.

"After my second stroke, my wife and daughters thought that was it, they would never see me again," Paul says. "The doctors told them there was not much they could do except wait. Then I somehow survived and have been getting progressively stronger."

One of the first encouraging signs was Paul's ability with languages - he speaks six - and he would switch from English to Portuguese to speak to one of his nurses.

"Unusually he learned several of his languages as an adult, and this will have created different wiring connections in the brain which have survived his stroke," says Dr Chandratheva.

Paul says he cannot read as fast as he used to, and is sometimes forgetful, but that's hardly surprising given the areas of damage in his brain.

His physical recovery has also been impressive, which doctors attribute to his previous very high level of fitness.

"I used to cycle for an hour a day, do a couple of gym sessions a week and swim in the river. My cycling and diving days are over, but I hope to get back to swimming," Paul says.

A study in the Lancet Psychiatry found brain complications in 125 seriously ill coronavirus patients in UK hospitals. Nearly half had suffered a stroke due to a blood clot while others had brain inflammation, psychosis, or dementia-like symptoms.

One of the report authors, Prof Tom Solomon of the University of Liverpool, told me, "It's clear now that this virus does cause problems in the brain whereas initially we thought it was all about the lungs. Part of it is due to lack of oxygen to the brain. But there appear to be many other factors, such as problems with blood clotting and a hyper-inflammatory response of the immune system. We should also ask whether the virus itself is infecting the brain."

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In Canada, neuroscientist Prof Adrian Owen has launched a global online study of how the virus affects cognition. Owen said: "We already know that ICU survivors are vulnerable to cognitive impairment. So as the number of recovered Covid-19 patients continues to climb, it's becoming increasingly apparent that getting sent home from the ICU is not the end for these people. It's just the beginning of their recovery."

"Sars and Mers, which are both caused by coronaviruses, were associated with some neurological disease, but we've never seen anything like this before," Dr Michael Zandi, consultant neurologist at the NHNN, told me. "The closest comparison is the 1918 flu pandemic. We saw then there was a lot of brain disease and problems that emerged over the next 10-20 years."

As the BBC's medical correspondent, since 2004 I have reported on global disease threats such as bird flu, swine flu, Sars and Mers - both coronaviruses - and Ebola. I've been waiting much of my career for a global pandemic, and yet when Covid-19 came along, the world was not as ready as it could have been. Sadly, we may have to live with coronavirus indefinitely. Here, I will be reflecting on that new reality.

A mysterious neurological syndrome known as encephalitis lethargica appeared around the end of World War One and went on to affect more than a million people worldwide. There is limited evidence of its causes, and whether the trigger was influenza or a post-infectious autoimmune disorder.

As well as a sleepiness coma, some patients had movement disorders that looked like Parkinson's disease, which affected them for the rest of their lives.

In his book Awakenings, the neurologist Oliver Sacks told the story of a group of patients who'd been frozen in sleep for decades, and how he used the drug L-Dopa to temporarily free them from their locked-in state.

We should be careful before reading too much into comparisons between Covid-19 and the 1918 Spanish flu pandemic. But with so many Covid patients having neurological symptoms, it will be important to look at the long-term effects on the brain.

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COVID-19 on the brain: BBC News at the National Hospital for Neurology and Neurosurgery – University College London Hospitals

BBC medical correspondent Fergus Walsh met with NHNN patient Paul Mylrea, 64, who is making a remarkable recovery after suffering two major strokes triggered by COVID-19 infection.

Im very lucky in physical terms but it has been tough, said Paul who had previously been very healthy and active and had a passion for diving.

After my second stroke, my wife and daughters thought that was it, they would never see me again. The doctors told them there was not much they could do except wait. Then I somehow survived.

Pauls first stroke was caused by a blood clot in his brain and happened while he was recovering from COVID-19 at University College Hospital. The clinical team also found blood clots in his lungs and legs so prescribed powerful blood-thinning drugs.

A couple of days later, however, he suffered a second, even bigger stroke and was transferred to the NHNN for specialist care.

Pauls consultant neurologist, Dr Arvind Chandratheva, said: I immediately assumed the blood-thinning drugs had caused a bleed in the brain but what we discovered was unlike anything we have seen before.

Despite the blood-thinning treatment, Pauls second stroke had been caused by another clot in his brain and blood tests showed that he had extraordinarily high levels of a clotting marker called D-dimer. Normally these levels are less than 300 and can rise to 1,000 in stroke patients but in Pauls case they were 80,000.

"I've never seen that level of clotting before something about his body's response to the COVID-19 infection had caused his blood to become incredibly sticky," said Dr Chandratheva.

It puzzled us why a fit and healthy man had experienced so many blood clots in rapid succession, despite blood-thinning treatment. But in just two weeks in April 2020, our team saw six people with COVID-19 who had similar strokes caused by a blocked, large artery in the brain.

We were witnessing the unfolding of a distinctive pattern of stroke associated with the pandemic.

Specialists at the NHNN have also seen an increase in COVID-19 patients with extensive inflammation in the brain. They do not think this is caused by COVID-19 itself but by the bodys immune system overreacting to the disease.

Consultant neurologist Dr Michael Zandi said: We are starting to see a number of effects of COVID-19 on the brain which are very concerning. For some people it could be devastating and life-altering.

We need to be prepared for decades of impact on peoples brains and mental health. The closest comparison we have is the 1918 flu pandemic when a lot of brain disease and problems emerged over the following 10 to 20 years."

Paul, who is a leading communications professional and speaks six languages, spent five weeks in hospital but is now recovering extremely well at home.

In the BBC report, we see Paul having online neurorehabilitation with clinical psychologist Dr Catherine Doogan and occupational therapist Kate Kelly as part of the N-ROL programme. The programme is led by Professor Nick Ward and supported by fundraising efforts by the charity SameYou to allow people to continue with their rehabilitation at home during the pandemic.

Paul said: I have been getting progressively stronger thanks to the ongoing care of the NHNN.

Here is the full news report, online articleand podcast(at 22m 20s).

For further information also see an article featuring Dr Chandratheva in The Conversation.

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Neurology Study: Contact Sports and Concussion in Rugby – LWOR – Last Word On Rugby

In a study that compared Rugby Players to Swimmers and Rowers, study author Ravi S. Menon, Ph.D., FRSC, of Western University in London, Canada, found that contact sports have a correlation with brain damage and concussion.

According to a new study published in the June 17, 2020, online issue of Neurology, the medical journal of theAmerican Academy of Neurology, the study compared rugby players to other female college athletes competing in the non-contact sports of swimming and rowing.

101 female college athletes took part in the study. This included 70 rugby players and 31 rowing or swimming athletes. The study followed a subset of the rugby players for at least two years. It also followed swimmers and rowers for one year.

In terms of rugby union, the fact that the tackler and the tackled player are at risk, is well established. What this study has found is that exposure at any level, can result in changes to a player [subject] microstructure of the white matter, including in nerve fibers that connect areas of the brain. This white matter controls basic emotions like fear, pleasure, and anger. In some of the rugby players, the changes progressed over time.

While any contact sport such as football, basketball, and American Football may result in injury. Rugby, with players intent to stop the forward progress of the opposition, putting bodies and especially heads, in a compromised position (in the contact area). These results indicate that only after a short term, affects can be found more in rugby union. More so than in non-contact sports.

Even with no concussions, the repetitive impacts experienced by the rugby players [even during training] clearly had effects on the brain, said Menon.

Researchers used magnetic resonance imaging (MRI) to scan the brains of all the athletes during in- and off-season play. With the brain scans, researchers examined how water molecules moved throughout the white matter. This was to determine if there were microstructural brain changes.

Researchers found differences in the functional organization of the brain too. When compared to swimmers and rowers, rugby players had changes in connectivity. How the brain communicates between the areas of the brain that control memory retrieval and visual processing.

While we only looked at these impacts during a few events during the season, previous research has shown these kinds of subclinical impacts may accumulate over years of participation in contact sports.

More research is needed to understand what these changes may mean and to what extent they reflect how the brain compensates for the injuries, repairs itself or degenerates so we can better understand the long-term health effects of playing a contact sport.

With growing evidence of new and established studies, many will conclude that the game is counter-productive. The risk is too large. Current players will, and continue to suffer from injury due to contact sports activity.

HIA tests today are risk-averse, to remove any player from harm. This head injury assessment can mean the difference between a serious injury and player welfare. Although, the results of the study by Western University prove that any exposure is harmful.

Head injury protocols have been issued by World Rugby. Players should aim to lower the tackle area. Promoting less impact that includes the head area should improve the welfare of players. Yet at the center of the argument is, that it is the choice of the individual.

In time, rule variations, reduced emphasis in the breakdown, changes to contact sports like rugby may alter the sport. But, the focus will and should focus on health and welfare first.

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The study was supported by the Schulich School of Medicine & Dentistry at Western University, the Canadian Institutes for Health Research, Brain Canada, Canada First Research Excellence Fund, and the Natural Sciences and Engineering Research Council of Canada.

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Higgins announces $2.2 million grant to UB to support Parkinson’s research – UB Now: News and views for UB faculty and staff – University at Buffalo…

Rep. Brian Higgins has announced that UB has received a five-year, $2,224,925 grant from the National Institutes of Health to develop a method to diagnose Parkinsons disease (PD) before clinical symptoms are present.

The funding was awarded by the National Institute of Neurological Disorders and Stroke of the NIH. Principal investigator is Jian Feng, professor of physiology and biophysics in the Jacobs School of Medicine and Biomedical Sciences at UB.

Parkinsons is a motor system disorder resulting from the loss of dopamine-producing cells in the brain. It currently is diagnosed by neurologists observing and rating clinical symptoms based on a standard criteria. To even exhibit the onset of clinical symptoms of PD, one must experience many decades of cellular deterioration.

UBsresearch aims to transform Parkinsons research and therapeutic development with the ability to diagnose PD earlier, allowing for the possibility of proactively preventing or delaying severe neuron decay. The research, titled Molecular Segregation of Parkinsons Disease by Patient derived Neurons will also aim to identify and separate two major subtypes of PD those who experience tremors and those who do not to be able to better treat specific types of PD.

The National Institutes of Health estimates that up to 1 million people in the United States may have Parkinsons disease. Thats 1 million Americans with a difficult, progressive condition without a cure who must wait until their clinical symptoms are serious enough to be diagnosed, Higgins said. This federal investment to assist our Western New York researchers hopes to provide a path to earlier detection of Parkinsons to attempt treatment as quick as possible.

When we generated induced pluripotent stem cells from a group of Parkinsons disease patients and a group of normal subjects, we found that there were many significant differences in the expression levels of genes controlling the production, utilization and degradation of dopamine, Feng said. Thus, we want to investigate this further with the goal of developing a method for the objective diagnosis of Parkinsons disease. It might also allow us to predict years in advance who may develop Parkinsons.

Higgins has been an advocate for measures that advance Parkinsons research and treatment.Following meetings with the Michael J. Fox Foundation,the Parkinsons Foundation of WNY and local advocate and former congressman Jack Quinn, Higgins sent a letter to the Department of Veterans Affairs and the Department of Health and Human Services last January urging that access to boxing therapy in the treatment of Parkinsons be expanded, as well as more research be conducted to document the efficacy of the program.In February, he drafted a bipartisan letter supporting funding for a surveillance database at the Centers for Disease Control and Prevention to collect vital demographic information on people living with neurological diseases,a measure supported by the Michael J. Fox Foundation.

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