Does COVID-19 Cause Brain Damage?

Cases of a rare type of brain inflammation, as well as incidences of stroke, have been particularly concerning.

Most people who contract COVID-19 will experience "mild to moderate respiratory illness and recover without requiring special treatment"—according to the World Health Organization (WHO). As COVID-19 has ravaged the globe, experts have discovered that the disease can manifest in many different ways—not just the typical cough, fever, and fatigue.

Researchers in a May 2022 study published in EClinicalMedicine had 46 patients complete computerized cognitive assessments as well as anxiety, depression, and PTSD measures following illness from COVID-19. The researchers found that there were significant cognitive deficits for COVID-19 patients who experienced severe illness from the disease. In other words, COVID-19 illness severity went hand-in-hand with later cognitive difficulties.

"COVID-19 has been associated with multiple neurologic symptoms such as headache, dizziness, myalgia, confusion, alteration of the sense of taste and smell, weakness, strokes, and seizures," William C. Davison MD, FAAN, neurologist at Northwestern Medicine Lake Forest Hospital, Illinois, told Health. Additionally, an April 2022 review of neurological components related to COVID-19 infection in the Journal of Chemical Neuroanatomy also noted reports of neurological-based illnesses such as encephalitis, neuromuscular disorders, and meningitis in COVID-19 patients. Further, the disease has also been known to be associated with acute disseminated encephalomeyelitis (ADEM).

"ADEM is an inflammatory reaction to the central nervous system," said Dr. Davison. This rare, potentially fatal condition is characterized by an attack on the body's myelin, the protective covering of nerve fibers in the central nervous system, by the body's immune system, per the National Institute of Neurological Disorders and Stroke (NINDS). If this protective covering is absent or inadequate, nerves are unable to effectively transmit information. The symptoms that may result from ADEM range from headache and fatigue to visual loss and paralysis.

Thus, there is evidence for how the nervous system in general—comprised of the brain, spinal cord, and nerves—can particularly be susceptible to the disease, even to the point of brain damage.

Researchers in the UK conducted a study, published in March 2022 in Nature, with the intent of finding connections between COVID-19 and changes to the brain. They looked at the brain scans of 785 individuals—401 of whom had experienced milder infections of the disease. The researchers found that, compared to the individuals in the control group, those who had contracted COVID-19 had shown more evidence of cognitive decline between the first and the second scan—indicating a link between COVID-19 and brain functioning.

Research has also suggested that COVID-19 could cause further brain damage through brain inflammation and nerve damage. For example, according to a March 2021 article published in JAMA Psychiatry, "SARS-CoV-2 can damage endothelial cells"—cells that guard the brain against pathogens or toxins as part of the blood-brain barrier. They added that damage to these cells could lead to both brain inflammation and brain damage.

Alex Sandoval

Strokes are another concern in relation to COVID-19, especially since strokes can cause brain damage independent of infection from the disease. According to the NINDS, acute COVID-19 infection can lead to complications concerning blood such as brain bleeding, weak blood vessels, and blood clots. In particular, blood clots can form due to COVID-19, and any internal damage to blood-related features—such as veins and capillaries—along with blood clots can cause strokes. Further, an April 2021 study from JAMA Network Open showed that individuals with COVID-19 were more at risk of experiencing acute ischemic strokes.

Even though there are only a few instances of severe cases of neurological complications due to COVID-19, it shows how challenging it can be for doctors treating COVID-19 patients. Patients who don't display severe respiratory symptoms, such as breathing difficulties, may not be tested for neurological complications early enough to avoid damage. "Some patients go from no symptoms and a normal outcome to multiple organ failure and even death," said Dr. Davison.

Still, experts are continuing to learn what's causing the presentation of neurological complications in COVID-19 patients. For example, the symptoms may present themselves as a result of the systemic impact of the illness, as COVID-19 doesn't seem to directly attack the brain. "Sometimes, these symptoms can be the result of systemic disease such as acute respiratory distress syndrome (ARDS), but other times may be related to either direct involvement of the virus to the nervous system or an abnormal immune response to the virus," added Dr. Davison.

To lessen the risk of experiencing neurological symptoms due to COVID-19, the Centers for Disease Control and Prevention (CDC) has provided ways to protect yourself against infection, such as monitoring your health on a daily basis, practicing social distancing, and wearing a mask. As of April 2022, the CDC has also recommended getting a COVID-19 vaccine and staying up to date with the vaccines. Lastly, if you or someone who may have become infected starts to experience any severe symptoms of COVID-19, like confusion or an inability to stay alert, seek immediate medical attention.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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