With inputs from Dr Monica Vasudev

 955: Update on Covid-19: IMA-CMAAO Webinar on “Neurological complications in Covid-19”

6th June, 2020, 4-5pm

Participants: Dr KK Aggarwal, President CMAAO, Dr RV Asokan, Hony Secretary General IMA, Dr Ramesh K Datta, Hony Finance Secretary IMA, Dr Sanchita Sharma

Faculty: Dr Jyoti Sehgal, Senior Consultant Neurologist, Medanta Medicity, Gurgaon

Key points from the discussion

• These patients are seen in triage, OPDs or as referrals from ICU from other departments.
• Neurological manifestations in Covid-19 patients may be of the central nervous system or peripheral nervous system.
• In CNS, the symptoms may be mild and nonspecific – headache, vertigo, fatigue, uneasy feeling or not feeling good.
• Patients with altered sensorium (irritability, confusional state, seizure-like), disorientation and encephalopathy are critical patients and admitted to ICU. These patients do not have symptoms of cough, fever, respiratory distress.
• There are no imaging findings on CT scan; their MRI may be normal; mildly high protein; treatment is symptomatic.
• Many patients come as stroke cases (hemiparesis, facial involvement, deficit which is measurable) in casualty; they are managed as per management of acute stroke and when hospitalized, are subjected to mandatory Covid test. Ischemic stroke is more common.
• In many patients, the first report may be negative, but the subsequent repeat test turns out to be positive.
• Patients can also present with epilepsy or seizure-like presentation.
• There are patients who have comorbid neurological conditions like Alzheimer’s, Parkinson’s, multiple sclerosis, motor neuron disease, who have altered sensorium or have stopped doing their daily activities for the last few days.
• Patients also have peripheral nervous system presentation, which can be anosmia, different sensation of smell, Bell’s palsy (infranuclear).
• Patients in ICU, patients on ventilators, present with critical illness polyneuropathy or critical illness myopathy.
• Patients who are on immunosuppressants, like MS, myasthenia, are more prone to disease relapses even if earlier were stable on low dose medication.
• Treatment is supportive; protection of staff and HCW; dedicated corridors and floors; dedicated CT scan machine. Once the report is negative, the family is also counseled and shifted to non-Covid ward.
• High D-dimer may be indicative of Covid stroke.
• LMWH is reserved for bed ridden patients (hemiplegia, paraplegia, transverse myelitis, GBS) as DVT prophylaxis.
• Neurological care in Covid: We have become more historical – good clinical and visual history is helping to make a clinical diagnosis as there is fear of examination; fewer investigations and more of clinical judgment; hospitalization is discouraged; relying on families and relatives as caregivers.

Dr KK Aggarwal

President CMAAO