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article imageRare brain condition observed in some COVID-19 patients

By Karen Graham     Apr 3, 2020 in Health
A small group of patients around the world, sickened by the COVID-19 virus, are showing an altered mental status, or encephalopathy, a catchall term for brain disease or dysfunction that can have many underlying causes.
CNN's Chris Cuomo, the younger brother of New York Governor Andrew Cuomo, announced this week that he tested positive for the coronavirus, but he's continuing to anchor his 9 p.m. ET show from his basement.
Wednesday night, he talked about the unrelenting fever: "This virus came at me, I've never seen anything like it, OK?" he said. "So I've had a fever, you've had a fever, right? But 102, 103, 103-plus, that wouldn't quit. It was like somebody was beating me like a pinata. I was shivering so much that ... I chipped my tooth. They call them the rigors."
And while Cuomo exhibited the fever, cough and difficulty breathing - typical hallmarks of infection with the new coronavirus, he also exhibited an altered mental status. "So the sun comes up, I'm awake—I was up all night. I'm telling you, I was hallucinating," said Cuomo.
"My dad was talking to me," he continued, referring to Mario Cuomo, former New York governor, who died in 2015. "I was seeing people from college, people I haven't seen in forever. It was freaky, what I lived through, and it may happen again tonight."
Acute necrotizing encephalopathy
A number of COVID-19 patients have gone on to develop a rare brain disease known as acute necrotizing encephalopathy, a condition that can be triggered by viral infections, including influenza A, influenza B and the human herpesvirus 6, according to GARD.
These infections can trigger a so-called cytokine storm in the brain when inflammatory substances that normally help the body fight off disease instead go haywire and damage the infected tissue. As an example, in early March, a 74-year-old man came to the emergency room in Boca Raton, Florida with a cough and a fever.
X-Rays ruled out pneumonia and the man was sent home. The next day, his fever spiked and he was brought back to the hospital with shortness of breath, however he could not tell doctors his name because he has lost his ability to speak. Doctors suspected he had Covid-19 and were eventually proven right when he was finally tested, according to the New York Times.
Newsweek is reporting that an unidentified 58-year-old COVID-19 patient in Detroit has been diagnosed with a rare type of brain damage known as acute necrotizing hemorrhagic encephalopathy, previously seen in patients with other viral infections.
Dr. Elissa Fory, a neurologist at Detroit's Henry Ford health system who helped to diagnose the woman, said in a statement the patient had experienced a fever, cough and muscle aches. She was rushed by ambulance to an emergency room on March 19, after becoming confused, lethargic and disoriented.
MRI scans showed abnormal lesions in parts of the woman's brain associated with consciousness, sensation and memory function, the statement explained. "The 58-year-old female patient is hospitalized in serious condition," the health system said.
Diana Berrent was the first coronavirus survivor in New York state to get screened hoping to donate ...
Diana Berrent was the first coronavirus survivor in New York state to get screened hoping to donate anti-body rich plasma
Diana Berrent, AFP
So much we don't know
There have been similar observations by doctors in Italy and other parts of the world, of Covid-19 patients having strokes, seizures, encephalitis-like symptoms, and blood clots, as well as tingling or numbness in the extremities, called acroparesthesia.
In some cases, patients were delirious even before developing a fever or respiratory illness, according to Dr. Alessandro Padovani, whose hospital at the University of Brescia in Italy opened a separate NeuroCovid unit to care for patients with neurological conditions.
The potential neurological symptoms of COVID-19 are not well understood and add to the difficulty in diagnosing COVID-19 in the elderly, but why neurobiological symptoms are showing up in younger people needs to be studied more.
Dr. Fory said: "This is significant for all providers to be aware of and looking out for in patients who present with an altered level of consciousness. We need to be thinking of how we're going to incorporate patients with severe neurological disease into our treatment paradigm. This complication is as devastating as severe lung disease."
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