H5N1

What's causing New Brunswick's mystery neurological disease? Worried residents want answers

Via CBC News: What's causing N.B.'s mystery neurological disease? Worried residents want answers Excerpt:.

News this week that a cluster of more than 40 cases of an unknown neurological disease have been identified and found only in New Brunswick has residents of several communities on edge. 

The mystery illness has similarities to Creutzfeldt-Jakob disease, a rare and fatal brain disease. 

First diagnosed in 2015, according to an internal Public Health memo sent this month to medical professionals, the disease affects all age groups and appears to be concentrated in the Acadian Peninsula in northeast New Brunswick and the Moncton region in the southeast. 

Forty-three cases have been identified, and five people have died. Since that news was reported on Wednesday, people in those communities have been wondering how alarmed they should be.   

 "People are wondering, what is it? Why is it only here? We are hoping that somebody will tell us," Anita Savoie Robichaud, the mayor of Shippagan, a town on the peninsula, said Friday. 

Yvon Godin, the mayor of Bertrand, a village further north on the peninsula, who also chairs the Forum of Acadian Peninsula Mayors, agrees. 

"We are very, very worried about it," Godin said. "Residents are anxious, they're asking 'Is it moose meat? Is it deer? Is it contagious?' We need to know, as fast as possible, what is causing this disease." 

Dr. Neil Cashman understands the concern. Cashman, a professor in the University of British Columbia's faculty of medicine, is a neurologist with a special expertise in prion diseases — a group of neurodegenerative diseases caused by proteinaceous infectious particles, or prions — including Creutzfeldt-Jakob disease. 

When Cashman first heard about the cases in New Brunswick, he says his first thought was, "We have a problem on our hands."

Eluru: Outbreak may be 'myoclonic epilepsy'

Via andhrajyothi.com: May be 'myoclonic epilepsy'. The Google translation from Telugu:

Guntur (Medical), Vijayawada, Visakhapatnam, December 7 (Andhra Jyoti): Doctors of the Guntur Government Comprehensive Hospital are inquiring into the causes of the strange disease that is rampant in Eluru. 

Patients show symptoms of epilepsy such as foaming at the mouth, headache, and fainting. Doctors refer to these as symptoms of myoclonic epilepsy in medical terminology. 

Five victims from Eluru with similar symptoms were shifted to Guntur GGH on Sunday for better treatment. Padavala Chalapathirao (65), P Sambulingachari (51), Kayala Kusumakumari (42), Padda Ramanamma (59) and Majeti Lakshmikumari Andallu (55) are currently receiving treatment here. They are being treated by a team of medical professionals under the supervision of Dr. Neelam Prabhavati. 

A special committee was appointed with seven medical professionals from different specialties. 

Victims in critical condition in Eluru are being shifted to Vijayawada Government Hospital. Four victims were brought here on Sunday. Another eight were evacuated on Monday. All types of tests were performed on patients. The cause of the disease is not known. 

GGH officials on Monday sent a team of five doctors to Eluru, thinking that the cause could be ascertained by examining the situation at the field level. The team toured the town of Eluru on Monday. Another medical team will leave Vijayawada GGH for Eluru on Tuesday. 

Vice President Aura  

Vice President Venkaiah Naidu has taken the initiative on the issue of hundreds of people falling ill with an elusive disease in Eluru. He was on a visit to Visakhapatnam when he first spoke to the Collector on Monday evening. He later spoke to Union Health Minister Harshavardhan. 

Victims were urged to take steps to provide better medical care immediately. It is suggested that the issue be resolved as soon as possible. Aims‌ then discussed with the medical team.

Poor smell, fatigue, neurological damage: Brazilian patients with COVID-19 sequelae can't get treatment at SUS

Via Pública: Poor smell, fatigue, neurological damage: Patients with COVID-19 sequelae can't get treatment at SUS. Excerpt from the Google translation:

“This virus took away my basic functioning, my memory, my communication, it took away my right to smell my children, to be able to taste my favorite food”, said Natália Spinelli, speech therapist and director of a child rehabilitation clinic, in a Facebook group that brings together patients with possible Covid sequelae.   

Natália, from Recife, Pernambuco, began to experience the symptoms of coronavirus infection on May 18 and, when the disease was cured, she thought the worst was over. But other effects started to appear: tiredness, cold sweat, body pain, “indescribable” fatigue.  

“I started to forget very simple things about work, online classes, my kids. The moment came when I had to register something online and the CPF and RG, which is something totally memorized, and I didn't remember it anymore. ” For her, "the post was infinitely worse than the days I was [with the disease]".   

In addition to Natália, Francisca Benedita was also not fully cured after the acute phase of the disease - the active infection - passed. Francisca, who is 45 years old and lives in Fortaleza, Ceará, was hospitalized for 60 days in the ICU; 22 of these passed intubated, with the aid of invasive mechanical ventilation.  

Today, four months after discharge, she deals with “a lot of headache, dizziness, lack of taste”.

“There are days when I feel the house is rotten, but it is my nose that is rotten, because I call people to come and nobody is feeling anything”, he describes. After Covid, she started to have weakness, high blood pressure, thyroid problem, as well as pulmonary sequelae. Today, he does private monitoring: "Either you die or you have money to pay for the consequences", he concludes.  

Natália and Francisca Benedita are two of the more than 5 million Brazilians cured of coronavirus until November 5, 2020 - after more than seven months of pandemic and 161 thousand deaths registered in Brazil. This number, 5.06 million recovered , appears prominently on the website of the Ministry of Health (MS) and on social networks of the federal government. However, reports from people who have had Covid and studies indicate that the consequences of the infection do not end when the virus is defeated by the body.   

One of the pioneering studies on the subject, from the Hospital Policlínico Universitário Agostino Gemelli, in Rome, Italy, indicated in July that only 12.6% of the participants did not show persistent symptoms after the cure. Of the remainder, 32% had one or two symptoms and 55%, more than three. The most persistent sequelae were fatigue (53.1%), difficulty breathing or dyspnoea (43.4%), joint pain (27.3%) and chest pain (21.7%).

The Public Agency talked to people who are experiencing these sequelae and to specialists and found that, even after Covid-19, patients face difficulties in accessing SUS and distrust on the part of family, friends and doctors themselves.   

Patients are advised to “seek a psychologist” 

“I have to learn to live with the headache that doesn't go away”, says Raphaela Fagundes, who is 35 years old and is an application driver in Bauru, in the interior of São Paulo. She and her nephew began to experience Covid's symptoms - tiredness, exhaustion, fever and headache - on September 18. 

They were medicated with chloroquine , azithromycin, prednisone, dipyrone and ivermectin, and 14 days later, following the cycle of the disease, their tests were negative, indicating that they were "cured". 

But the pains persisted. "The drugs that were giving me morphine, cortisone were not taking the pain away," said the driver. 

Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study

Via medRxiv: Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study. The abstract:

Case studies have revealed neurological problems in severely affected COVID-19 patients. However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of severity. We analysed cognitive test data from 84,285 Great British Intelligence Test participants who completed a questionnaire regarding suspected and biologically confirmed COVID-19 infection. 

People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders. They were of substantial effect size for people who had been hospitalised, but also for mild but biologically confirmed cases who reported no breathing difficulty. 

Finer grained analyses of performance support the hypothesis that COVID-19 has a multi-system impact on human cognition.

Covid-19 may cause sudden, permanent hearing loss – UK study

I'm dealing with increasing deafness as it is, so this Guardian report is especially worrying: Covid may cause sudden, permanent hearing loss – UK study | World news. Excerpt:

Covid-19 may cause sudden and permanent hearing loss, experts have found, adding that such problems need early detection and urgent treatment.  

The coronavirus has been found to affect the body in myriad ways, from a loss of taste and smell to organ damage. Now doctors have reported fresh evidence that Covid could also affect hearing. 

Writing in the journal BMJ Case Reports, experts at University College London report the case of a 45-year-old man with asthma who was admitted to intensive care with Covid, ventilated, and given drugs including the antiviral remdesivir and intravenous steroids. 

A week after leaving intensive care he developed a ringing sound – tinnitus – and then hearing loss in his left ear.  

The team say none of the medications the man was given would be expected to cause damage to his hearing, while he had no problems with his ear canals or ear drums. Further investigation showed no sign of autoimmune problems, while he did not have flu or HIV – conditions previously linked to hearing loss. What’s more, the man had never had hearing problems before.  

Subsequent tests revealed the man had sensorineural hearing loss in his left ear – a situation where the inner ear or the nerve responsible for sound is inflamed or damaged. This was treated with steroids with partial success. 

The case is the first such incident to be reported in the UK, although a small number of similar reports have emerged from other countries. 

Dr Stefania Koumpa, a co-author of the study, said it is not yet known how Covid might cause hearing loss, but there are possible explanations. 

“It is possible that the Sars-Cov-2 virus enters inner ear cells and brings about cell death, and/or causes the body to release inflammatory chemicals called cytokines that can be toxic to the inner ear,” she said. “Steroids likely help by reducing inflammation and therefore production of cytokines.” 

The team say Covid patients in intensive care should be asked about hearing loss and referred for emergency treatment.  

“Even single-sided hearing loss has great consequences on one’s quality of life, if not promptly treated,” said Koumpa.  

Kevin Munro, professor of audiology at the University of Manchester, who was not involved in the work, said it is known that other viruses, including measles and mumps, can affect hearing, while he has been contacted by a large number of Covid survivors reporting a change in their hearing or tinnitus.

Covid-19 patient with no respiratory symptoms suffers brain damage

Via the South China Morning Post: Covid-19 patient with no respiratory symptoms suffers brain damage. Excerpt:

A Covid-19 patient who had no respiratory symptoms has suffered a neurological disorder in a case that has caused concern among some scientists. 

The 30-year-old man from Texas had difficulty speaking and walking – signs of a malfunction in the cerebellum, the part of the brain that controls coordination and balance – but had no fever, cough, chest pains or other typical symptoms. 

“Covid-19 has not yet been reported as a cause of acute viral cerebellitis without associated respiratory symptoms,” wrote Adriana Povlow and Andrew Auerbach, from the University of Texas Health Science Centre, in the study published in the Journal of Emergency Medicine on Friday. 

Doctors in China have previously warned that the virus could cause brain damage.  

More than a third of patients in Wuhan, where the disease was first detected, suffered impaired consciousness, seizures, loss of smell or sight, nerve pain and other neurological disorders, according to a study published in April. 

Other patients in other parts of the world have also been reported to have suffered a “brain fog” for months after being discharged from hospital, but they have mostly been elderly and the brain damage was always accompanied by other symptoms. 

Other cases of acute cerebellitis have also been recorded in Covid-19 patients but these patients also showed respiratory symptoms. 

The doctors in San Antonio initially thought the patient, who was vomiting, slurring his speech and walking unsteadily, had suffered a stroke. 

Brain scans found no bleeding in the head, but X-ray images revealed some mild inflammation in the upper lungs. A PCR test confirmed the coronavirus infection. 

The patient spent 10 days in hospital without developing any sign of respiratory symptoms, according to the doctors. 

Though there was some improvement in his neurological symptoms, he was still unable to walk unaided at the time of his discharge.

Stroke risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases

Via Neurology: Stroke Risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases. The abstract:

Objectives: To investigate the hypothesis that strokes occurring in patients with COVID-19 have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population. 

Methods: We performed a systematic search resulting in 10 studies reporting stroke frequency among COVID-19 patients, which were pooled with one unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in COVID-19 patients (n=125) and we pooled these data with 35 unpublished cases from Canada, USA, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50-70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death.  

Results: The proportion of COVID-19 patients with stroke (1.8%, 95%CI 0.9-3.7%) and in-hospital mortality (34.4%, 95%CI 27.2-42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years-old relative to those >70 years-old (OR 0.33, 95%CI 0.12-0.94, P=0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbidities. A clinical phenotype characterized by older age, a higher burden of comorbidities, and severe COVID-19 respiratory symptoms, was associated with the highest in-hospital mortality (58.6%) and a 3x higher risk of death than the rest of the cohort (OR 3.52, 95%CI 1.53-8.09, P=0.003).  

Conclusions: Stroke is relatively frequent among COVID-19 patients and has devastating consequences across all ages. The interplay of older age, comorbidities, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.

See also this Globe and Mail article on the study.

COVID-19 associated with acute hemorrhagic necrotizing encephalitis

Thanks to FluTrackers for tweeting, and Jason Kindrachuk for retweeting, this link to this article in the Journal of Case Reports: SARS-CoV-2-Associated Acute Hemorrhagic, Necrotizing Encephalitis (AHNE) Presenting with Cognitive Impairment in a 44-Year-Old Woman without Comorbidities: A Case Report. The authors are on the faculty Burdwan Medical College in India.

BACKGROUND: 

Acute hemorrhagic necrotizing encephalitis (AHNE) is a rare manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. AHNE usually involves the subcortical white matter but not the cortical grey matter. This study describes the disruptive effects of AHNE associated with SARS-CoV-2 on cognitive function in a previously healthy and sound middle-aged woman resulting from alterations in cortical areas involved in the cognitive network. 

CASE REPORT: 

A 44-year-old previously healthy woman with a history of inter-state travel developed a flu-like illness, followed by acute, steadily progressive cognitive impairment. She was admitted in a comatose state after a first tonic-clonic seizure. Blood tests were non-informative. Cerebral magnetic resonance imaging (MRI) was indicative of AHNE. Cerebrospinal fluid analysis showed mild lymphocytosis with normal protein and normal glucose but an elevated IgG index. After testing positive for SARS-CoV-2, she was administered steroids. Treatment was ineffective, and the patient died. 

CONCLUSIONS: 

SARS-CoV-2 is a potential central nervous system (CNS) pathogen, which may manifest as AHNE. These patients may present with generalized tonic-clonic seizures and frontal dysexecutive syndrome, with cognitive impairment being the presenting feature of neuro-coronavirus disease-2019 (COVID-19). The patient described in this report is unique for acute-onset and isolated cognitive impairments due to SARS-CoV-2 infection in the absence of clinical or radiological respiratory manifestations. 

These findings may help in the early detection and diagnosis of neuro-COVID-19, especially among clinicians and neurologists working in areas of endemic SARS-CoV-2 infection.

Coronavirus and the brain: Diagnosing and treating COVID-19's neurological effects

Via The Conversation, an article by Professor John F. Connolly of McMaster University: Coronavirus and the brain: Diagnosing and treating COVID-19's neurological effects. Excerpt:

As the number of COVID-19 patient records grows, researchers are meticulously combing through the data, searching for a better understanding of the virus and what we can expect in the months and years ahead. What is now of increasing concern in health care is the realization that the virus can not only be severe, but can also have long-term consequences. 

Respiratory and skeletal muscle consequences surfaced earlier in the pandemic. More recently, the neurological and neurocognitive aspects of the virus have become a major concern. The neurocognitive symptoms linked to coronaviruses, counting COVID-19, include delirium, both acute and chronic attention and memory deficits linked to hippocampal and cortical damage, as well as learning deficits in both adults and children.  

These symptoms feature significantly in a large percentage of COVID-19 patients. In March, a study reported 36.4 per cent of COVID-19 patients have neurological symptoms, including headache, disturbed consciousness and paresthesia (a burning or prickling sensation in parts of the body such as hands, legs and feet). Not surprisingly, severely affected patients are more likely to develop neurological symptoms than patients who have mild or moderate disease. 

More recently, a report published in early June in the New England Journal of Medicine reported that 84 per cent of the patient sample had neurologic symptoms. Also, a recent paper in the Lancet using autopsy reports on patients who had severe cases noted brain tissue edema (a life-threatening condition that causes fluid to develop in the brain, causing pressure inside the skull) and neuronal degeneration (when a brain’s neurons break down, lose connectivity and affect brain function).  

Assessing neurological symptoms 

The percentage of COVID-19 patients with neurological symptoms varies greatly between studies. One of the reasons is inconsistent assessment methods. Research has shown behavioural assessment (testing based on things like the patient’s visual responses, motor function and communication) is frequently inaccurate.

Reliable neurocognitive assessment procedures will be essential both in accurately assessing active and post-COVID patients’ cognitive abilities, and in tracking their recovery. Objective assessments of brain function can help pinpoint when neurocognitive symptoms begin to appear in COVID-19 patients, which patient groups are at a higher risk, how long neurological effects may last and what treatments are most effective. In the early stages of understanding COVID-19 and researching the neurological effects, definitive facts around these issues remain unknown.

Warning of serious brain disorders in people with mild COVID-19 symptoms

Via The Guardian: Warning of serious brain disorders in people with mild coronavirus symptoms. Excerpt:

Doctors may be missing signs of serious and potentially fatal brain disorders triggered by coronavirus, as they emerge in mildly affected or recovering patients, scientists have warned.  

Neurologists are on Wednesday publishing details of more than 40 UK Covid-19 patients whose complications ranged from brain inflammation and delirium to nerve damage and stroke. In some cases, the neurological problem was the patient’s first and main symptom.  

The cases, published in the journal Brain, revealed a rise in a life-threatening condition called acute disseminated encephalomyelitis (Adem), as the first wave of infections swept through Britain. At UCL’s Institute of Neurology, Adem cases rose from one a month before the pandemic to two or three per week in April and May. One woman, who was 59, died of the complication. 

A dozen patients had inflammation of the central nervous system, 10 had brain disease with delirium or psychosis, eight had strokes and a further eight had peripheral nerve problems, mostly diagnosed as Guillain-Barré syndrome, an immune reaction that attacks the nerves and causes paralysis. It is fatal in 5% of cases. 

“We’re seeing things in the way Covid-19 affects the brain that we haven’t seen before with other viruses,” said Michael Zandi, a senior author on the study and a consultant at the institute and University College London Hospitals NHS foundation trust.  

“What we’ve seen with some of these Adem patients, and in other patients, is you can have severe neurology, you can be quite sick, but actually have trivial lung disease,” he added. Advertisement 

“Biologically, Adem has some similarities with multiple sclerosis, but it is more severe and usually happens as a one-off. Some patients are left with long-term disability, others can make a good recovery.”  

The cases add to concerns over the long-term health effects of Covid-19, which have left some patients breathless and fatigued long after they have cleared the virus, and others with numbness, weakness and memory problems.  

One coronavirus patient described in the paper, a 55-year-old woman with no history of psychiatric illness, began to behave oddly the day after she was discharged from hospital.

She repeatedly put her coat on and took it off again and began to hallucinate, reporting that she saw monkeys and lions in her house. She was readmitted to hospital and gradually improved on antipsychotic medication.  

Another woman, aged 47, was admitted to hospital with a headache and numbness in her right hand a week after a cough and fever came on. She later became drowsy and unresponsive and required an emergency operation to remove part of her skull to relieve pressure on her swollen brain.  

“We want clinicians around the world to be alert to these complications of coronavirus,” Zandi said. He urged physicians, GPs and healthcare workers with patients with cognitive symptoms, memory problems, fatigue, numbness, or weakness, to discuss the case with neurologists. 

“The message is not to put that all down to the recovery, and the psychological aspects of recovery,” he said. “The brain does appear to be involved in this illness.” 

The full range of brain disorders caused by Covid-19 may not have been picked up yet, because many patients in hospitals are too sick to examine in brain scanners or with other procedures. “What we really need now is better research to look at what’s really going on in the brain,” Zandi said.