Brain Stroke in Covid

Brain Stroke in Covid. Neurosurgeon Dr Arun L Naik discusses brain stroke in covid. Covid illness leads to brain stroke in many people. Brain stroke signs and symptoms are weakness and speech arrest. Signs and symptoms of covid 19 are present. RTPCR test for COVID-19 should be done. Treatment of covid is according to protocol. India is witnessing the devastating second wave, some countries, third wave. Fortunately covid is a mild illness in 99% of cases. In those unfortunate 1% cases, the virus is in the severe form. One most dreaded complication which is often fatal in seriously ill patients is brain stroke.

The clinical course of COVID-19 evolves in three phases. In the first infection phase, the inflammatory response is localized to the nose and upper respiratory tract. During this phase, the patient is infected and transmits the disease to others. If the immune system is not able to fight out the virus, then the second phase happens. Here the virus marches down through the windpipe to enter its favorite resting place, lungs. Lungs are also rich in their gateway; ACE 2 receptors. Here the virus causes lung damage, lack of oxygen, and heart  dysfunction. In the third phase, there is cytokine storm along with multiple body organs dysfunction and those notorious blood clot formation killing hundreds, young and old. 

Covid is more dangerous in Elderly patients with comorbidities, like hypertension, diabetes, heart disease, lung liver or kidney disease. The virus enters the brain via two ways. First, via Blood route and second through our nose and smell nerve olfactory system. Once inside the brain, the virus needs that Angiotensin-converting enzyme 2 or ACE2 receptors, as gateways to enter. Brains arteries have endothelial cells which are rich in ACE2 receptors.  

covid affects brain mainly by 4 ways
1. By blockage of ACE2 pathways: Covid primarily affects the lungs and brain is the second organ which it likes to invade.
2.Extensive blood clot formation: COVID causes extensive blood clot formation in organs. We call it DIC disseminated intravascular coagulation. 
3.Cytokine storm: Cytokines are crucial mediators of the inflammation in our body against any infection. When this normal immunity becomes exaggerated, you have a condition called cytokine storm.
4.Autoimmunity: This happens after a few weeks of covid. Here body’s immune cells target brain and spinal cord causing two devastating neuro disorders. Encephalitis and transverse myelitis.

What are the neurologic symptoms of covid
1.Common symptoms: Headache, dizziness, sleeplessness, irritability, bodyache, and malaise. 
2.Loss of smell and taste: This is the most striking neurological manifestation of COVID-19.
3.Encephalopathy and encephalitis: Here patient slips in to confusion, delirium, stupor and finally to  coma. and MRI hyperintensities in the visual cortex. Outlook is not good here.
4.Brain Stroke: commonest type stroke is ischemic Brain stroke which is caused by blood clot blocking the brain arteries. Second cause is brain hemorrhage where an artery inside the brain rupture causing bleeding. This happens with raised blood pressure.
5.Myelitis: Here the Spinal cord is involved and we call it Guillain Barre syndrome. It causes paralysis of all 4 limbs, urinary incontinence and breathing difficulty. Sometimes they land up on ventilator. Fortunately outlook in myelitis is not that bad. With proper treatment many of them retain their neurological function in a few months. 
6.Neuropathy: Covid also affects our nerves causing nerve damage. One of my patients had severe facial pain called trigeminal neuralgia after 4 weeks of covid illness which is still persisting after 6 months.
7.Seizures or convulsions: a few of my patients had seizures although it is uncommon. 
8.Mental depression and stress: COVID causes a lot of mental issues. I will have a separate vdo for the same. 

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