Months later, COVID-19 continues to impact communities around the world. Its wide variety of presentations make screening and accurate diagnosis challenging when relying on symptoms alone. Over these first few months we have learned much about the disease. Interestingly, doctors have observed a number of cases where neurological deficits from COVID-19 have been the primary presentation.

COVID-19 Triggering Autoimmune Neurological Deficits

Two case reports of Guillain-Barré Syndrome variants in patients with COVID-19 raised the concern for the virus triggering autoimmune-mediated neurological impairment. Thankfully, the patients in both cases recovered well with treatment. They presented with a mixture of diplopia, parasthesias, gait instability, nystagmus, and limited eye movement, primarily showing deficits in the cranial nerves. While their symptoms were different, they likely shared a common etiology. 

Strokes in Young and Healthy Patients

Another article brought to light a possible trend of young, otherwise healthy patients presenting with large-vessel ischemic strokes while infected with COVID-19. In these cases, patients had poor outcomes and traditional treatments,such as tPA and thrombectomy appeared to potentially backfire. 

How COVID-19 Gets In

Much of this may be explained by what appears to be the virus’ pathway into the body: infecting the angiotensin-converting enzyme 2 receptors, which are present in many tissues, including endothelial cells. This may explain the diverse presentations of the virus affecting all parts of the body. In response to these findings, some hospitals are raising the prophylactic doses of blood thinners to avoid emboli formation for COVID-19 patients in the hospital. 

Another recent article put these findings nicely together in a coherent narrative. If COVID-19 is primarily attacking receptors on endothelial cells, it would certainly explain much of what we are seeing. There are clear pulmonary symptoms. However, more and more it seems the disease may not be centered on the lungs, but that respiratory issues are a downstream consequence. Damage to blood vessels would explain the high rate of blood clots observed, plaque rupture, and other cardiovascular complications. 

Tracking Cognitive Function for COVID-19 Patients

It’s important to track our patients during illness and recovery from COVID-19. Neurological symptoms are no exception. BrainCheck can help track any cognitive deficits and ensure patients return to baseline. And as their provider, BrainCheck can provide you with insight into how best to target rehabilitation.

Learn more about the science behind BrainCheck »

About the author

Reza Hosseini Ghomi, MD

Reza Hosseini Ghomi is a practicing neuropsychiatrist, focusing on neurodegenerative disorders. In addition to serving as Chief Medical Officer at BrainCheck, he is a partner at Avicenna Telepsychiatry, faculty member of the University of Washington department of neurology and UW Institute for Neuroengineering, and an affiliate at the eScience Institute. Dr. Ghomi received his MD from the University of Massachusetts Medical School, has post-graduate training in in psychiatry and neurology with a focus on memory and movement disorders, and holds an MSE in biomedical and electrical engineering from Johns Hopkins University.

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