Is stress from COVID pandemic resulting neurological complications in youth?

Dr. Rajnish Kumar,  Sr. Consultant & Unit Head, Neurology, Paras Hospitals, Gurgaon

Neurological complications have emerged as a significant cause of morbidity and mortality in the ongoing COVID-19 pandemic. Beside respiratory insufficiency, many hospitalized patients exhibit neurological manifestations ranging from headache and loss of smell, to confusion and disabling strokes.Youth are at the receiving end because they are undergoing many stressful factors, including changes in job responsibilities, sick friends or family, fear of illness, and general uncertainty for the future. This along with the COVID-19 infection is also anticipated to take a toll on the nervous system in the long term.

COVID-19 wreaks havoc on our bodies, including our brain. The verdict is out whether the brain is directly infected or is responsive to body-wide inflammation. Infection with COVID-19 in hospitalized patients has been associated with altered mental status, seizures, and stroke. Even after the infection stabilizes and clears, residual symptoms remain in the form of persistent brain fog, dizziness, and headaches in so-called COVID long haulers.

Cognitive Impact

COVID-19 is most widely known to damage the respiratory system, but research has shown that the nervous system is also affected, which could have lasting neurological consequences. A study done at Northwestern Medicine Healthcare System showed that 42% of admitted COVID-19 patients presented neurological symptoms at the onset of the disease, and 82% showed neurological symptoms overall. Nearly 32% had cognitive dysfunction. While the causes of dysfunction vary, there is always the potential for long-term complications, as the brain damage observed in COVID-19 survivors has caused cognitive, behavioral, and psychological changes. Lack of oxygen and encephalitis, or swelling of the brain, seem to be two of the leading causes of this damage and could ultimately lead to stroke.

The dangerous side of these potential complications is that they are not always linked to the severity of the disease. Researchers in China evaluated patients that seemingly recovered from the virus and found that cognitive issues like difficulty in paying attention for long periods of time prevailed. In addition to causing serious daily complications, those that have had a stroke are at higher risk of developing dementia later in life.

Some researchers think the unbalanced immune system caused by reacting to the coronavirus may lead to autoimmune diseases, but it’s too early to tell. Anecdotal reports of other diseases and conditions that may be triggered by the immune system response to COVID-19 include para-infectious conditions that occur within days to a few weeks after infection:

• Multi-system infammatory syndrome – which causes inflammation in the body’s blood vessels
• Transverse myelitis – an inflammation of the spinal cord
• Guillain-Barré sydrome (sometimes known as acute polyradiculoneuritis) – a rare neurological disorder which can range from brief weakness to nearly devastating paralysis, leaving the person unable to breathe independently
• Dysautonomia – dysfunction of the autonomic nerve system, which is involved with functions such a breathing, heart rate, and temperature control
• Acute disseminating encephalomyelitis (ADEM) – an attack on the protective myelin covering of nerve fibers in the brain and spinal cord
• Acute necrotizing hemorrhagic encephalopathy – a rare type of brain disease that causes lesions in certain parts of the brain and bleeding (hemorrhage) that can cause tissue death (necrosis)
• Facial nerve palsies (lack of function of a facial nerve) such as Bell’s Palsy
• Parkinson’s disease-like symptoms have been reported in a few individuals who had no family history or early signs of the disease

Role of vaccination

Almost everyone should get the COVID-19 vaccination. It will help protect you from getting COVID-19. The vaccines are safe and effective and cannot give you the disease. Most side effects of the vaccine may feel like flu and are temporary and go away within a day or two. In early vaccine development, there were extremely rare reports of unexplained neurological illness following COVID-19 vaccination, but regulators found no evidence the vaccines caused the illness. The U.S. Food and Drug Administration (FDA) continues to investigate any report of adverse consequences of the vaccine and none have appeared as of yet. Consult your primary care doctor or specialist if you have concerns regarding any pre-existing known allergic or other severe reactions and vaccine safety. Scientists are studying the risk to benefit ratio of the vaccine in someone who previously developed Guillain Barré syndrome after a vaccination. The general sense is the COVID-19 vaccine is safe in individuals whose Guillain-Barré syndrome was not associated with a previous vaccination.