56th Annual Irish Neurological Association Meeting, 1-2 October 2020
Prof Patrick Mallon, Professor of Microbial Diseases in the UCD School of Medicine and Consultant in Infectious Diseases in St Vincent’s University Hospital, spoke at the 56th Annual Irish Neurological Association Meeting about the neurological manifestations arising from SARS-CoV-2 infection. “There are a lot of knowledge gaps surrounding the neurological symptoms of Covid-19,” Prof Mallon warned the virtual audience, before detailing what has been observed in St Vincent’s University Hospital over the last six months with regard to Covid-19 and the brain.
There have been atypical presentations of Covid-19 in the elderly in the form of delirium, something that was noted as early as March. A number of elderly individuals, later proven to have Covid-19, did not present with the typical influenza-like illness – they had no temperature response and no respiratory symptoms. Instead, these individuals presented with acute delirium, of which there were “variable backgrounds of cognitive state”. As a result of this, St Vincent’s University Hospital widened their scope of classification for potential Covid-19. Now, individuals coming from a nursing home with any atypical presentation are “regarded as Covid until proven otherwise”.
Many young people have presented to the hospital with what appeared to be severe lymphocytic meningitis “on the background of an influenza-like illness”, which was often accompanied by a SARS-CoV-2 positive PCR result. The cerebrospinal fluid (CSF) of these patients tested negative for SARS-CoV-2, while the MRI findings were not consistent with encephalitis.
There have been a number of SARS-CoV-2 infected patients, from a range of different ages, presenting with new onset seizures. Prof Mallon stated that it is difficult “within the setting of a pandemic” to discern whether these individuals “just happen to have a Covid-19 infection” or whether these seizures are arising secondary to acute Covid-19 infection. This is not something they have been able to differentiate to date.
Many Covid-19 patients have also suffered strokes over the last six months. Prof Mallon said, once again, it is hard to discern whether the strokes arose from Covid-19, or whether they simply presented alongside Covid-19. However, as Covid-19 is already associated with other thrombotic complications such as pulmonary embolism and venous thromboembolism, Prof Mallon and his colleagues believe that the vascular abnormalities resulting from Covid-19 are likely to be contributing to higher incidences of stroke in Covid-19 patients.
Prof Mallon also touched on post-Covid syndrome, or long-Covid syndrome, and the associated neurological symptoms arising from this complication. He reported that it appears to be the individuals who did not suffer Covid-19 severely and initially required no hospital attention who are acquiring post-Covid syndrome. These patients are presenting with a number of prolonged objective and subjective symptoms. The main neurological complaint from these patients is ‘brain fog’. More specifically, patients are suffering from a lack of concentration and have difficulties with basic arithmetic. At this point, Prof Mallon referenced the case of a woman in her 50s who contracted Covid-19 six months ago.
Prior to infection, this woman was running her own business, which is spread across a number of locations in Ireland. After taking some time off during her illness, this woman returned to work and found she was no longer able to do the arithmetic associated functions required to run a business. Furthermore, when she returned to play bingo with her son, she found that she was also unable to follow the numbers within the game. “This is of ongoing and significant concern to the woman, as it was six months ago that she contracted the virus,” Prof Mallon said.