Global Health Asia-Pacific September 2020 September 2020 | Page 49

obesity. Some have been completely normal prior to
COVID-19 and the stroke.
In one study of 10 strokes, four patients died, two
of them from the virus affecting the lungs and the
other two directly from the stroke. The �lobal Covid-19
Stroke �egistry has found that COVID-19 patients
with acute ischemic strokes (AIS) had worse strokes,
worse functional outcomes, and a higher mortality
than AIS in non COVID patients. This study analysed
��0 strokes globally during the pandemic period from
�anuary to �une 2020. The increased propensity for
thrombotic events, cardiac injury, cardiac arrhythmias,
and cytokine release syndrome was among several
factors thought to be responsible for AIS in COVID-19
patients.
Other serious neurological problems found with
COVID-19 include febrile seizures, convulsions,
changes in mental status, and associated
encephalomyelitis, and encephalitis. In a recent
study, T neurological manifestations of the SA�S-
CoV2 virus were found in 25 percent of patients,
including headaches (13 percent), giddiness (17
percent), impaired consciousness (8 percent), acute
cerebrovascular problems (� percent), seizures
(0.� percent), and ataxia (0.� percent). The virus is
neurotrophic, meaning it can infect nerve cells, and
can be isolated from the cerebrospinal �uid of some of
these patients. Other reasons for seizures in COVID-19
patients include hypoxia, multiorgan failure, and
severe metabolic and electrolyte derangements.
Confusion and an altered mental state have been
shown to be associated with encephalitis including
acute demyelinating encephalomyelitis (ADEM) as
well as psychiatric conditions including psychosis,
a dementia like syndrome, and mood disorders in
COVID patients. There is also a group of COVID
patients who initially have mild �u symptoms who
develop �uillain �arre syndrome with peripheral
nerve problems that can cause paralysis and require
ventilation and ICU care.
In conclusion, we have not completely understood
the neurological problems associated with COVID-19
at this stage of the pandemic. Some of these problems
may cause long term cognitive, motor, and emotional
dysfunction. �ewer digital technologies to monitor
brain function in conjunction with telemedicine may
help us monitor communities to help in the early risk
stratification and prediction of an impending COVID-19
infection and with the long term monitoring of affected
individuals.
Dr Prem Pillay,
MBBS (NUS,
Singapore)
FRCS(Canada)
FRCS(Ed, UK)
FACS(USA), is the
medical director
of the Singapore
Brain Spine Nerves
Center.
GlobalHealthAndTravel.com
SEPTEMBER-OCTOBER 2020
47