The Covid-19 can Attack the Brain – Jesse Santiano M.D.

A report coming from the Beijing Ditan Hospital talked about a patient infected with Covid-19 who had multiple organ system failures with brain involvement.

The 56-year-old patient was admitted on Jan 12 and developed severe respiratory distress syndrome (ARDS), heart damage, abnormal clotting, kidney failure, and liver damage. He was being managed aggressively with antiviral and antibiotics and other medications without improvement.

He was later noted to have frequent twitching of the facial muscles with persistent hiccups. When examined, he had physical signs of brain inflammation. A spinal tap was done, and it revealed a high pressure in the brain. The recovered cerebrospinal fluid (CSF) was clear.

Gene sequencing of the CSF was done, and the Covid-19 virus was identified in the CSF. The treatment was then adjusted to address the high pressure in the brain with medications. Antiseizure medicine, and gamma globulins to fight the virus were also given. The patient was also put on a mechanical ventilator to help him breathe.

The good news is that the patient recovered and was eventually discharged on Feb 25.

Liu Jingyuan is the director of the ICU at the Beijing Ditan Hospital and also took care of the patient. He said that there were other cases of Covid-19 with brain involvement, and some of them manifest as sudden disturbances of consciousness and even coma.

He recommends that the management of Covid-19 patients should include neurological evaluation to make appropriate diagnostic procedures, including the nucleic acid and gene sequencing, to identify any brain involvement in Covid-19 patients.

1311_Brain_Stem — The Brain Stem is made of the Midbrain Pons and Medulla

How can the Covid-19 get to the brain?

In another report, the authors talked about how the Covid-19 can get to the brain.

In it, the neuroinvasive properties of the Covid-19 were derived from its similarities with the Severe Respiratory Syndrome coronavirus or SARS CoV, and Middle Eastern Respiratory Syndrome coronavirus, MERS CoV. Both viruses were known to have infected the brain during their period of epidemics in 2003 and 2012, respectively.

The way the coronavirus enters the brain is probably by the olfactory nerves. The olfactory nerves are inside the nose and detect scents. These nerves travel directly into the brain thru the roof of the nose.

Studies among mice have shown that when the SARS CoV and MERS CoV are introduced in the intranasally, they enter the brain, possibly thru the olfactory nerves. Once inside the brain, the virus spread to specific areas like the brain stem.

The brainstem is where the respiratory center is located and is responsible for spontaneous breathing. That is why we don’t have to consciously breathe.

When the coronavirus infects the brain stem, the spontaneous breathing becomes impaired, and if not addressed right away, the patient can die. One 24-year-old patient said that she must stay awake and breathe consciously and actively while in the intensive care unit. She was afraid that if she fell asleep, she might die because she had lost her natural breath.

This breathing problem most likely contributes to the respiratory failure that happens in 89% of critically ill Covid-19 patients.

The takeaway message in this article is that the Covid-19 virus can infect the brain, and early recognition and treatment are essential for faster recovery of the patient.

The authors in the second report concluded that wearing a mask will absolutely
be the most effective measure to protect against the possible entry of the virus into the central nervous system.

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