COVID-19, in the early months of the pandemic, was considered as a disease affecting the lungs and circulatory system. However, with time, evidence has started to accumulate where it is found to be causing rare and unsuspected diseases in its patients. One such disease is Acute Hemorrhagic Leukoencephalitis (AHL), whose link to Covid has been reported in a few cases outside India and doctors have started calling it as Covid Encephalitis.
One such case was reported in Indraprastha Apollo Hospital where the patient suffered this disease after contracting the COVID-19.
A 55-year-old man, with co-morbidities, had contracted COVID-19 with mild symptoms and isolated himself at his home in Jammu.
“Being a diabetic and patient of hypertension, his condition started deteriorating within days. Blood oxygen saturation levels plummeted and he was admitted in a local hospital where doctors found his lungs infected with pneumonia. The patient was put on a ventilator. However, when his health did not improve, he was flown to Apollo via air ambulance,” said Dr Rajesh Chawla, Senior Consultant, Pulmonology & Respiratory Disease at Apollo told IANS.
The doctors here continued to keep him on the ventilator. Meanwhile, they administered him sedatives and muscle relaxants for appropriate ventilation. Chawla said that the condition of the patient’s lungs improved within a few days after which, he was removed from anaesthetic drugs.
However, the patient did not respond even after hours of removal from the sedatives, and was later discovered to have gone into a deep state of coma. The later investigation revealed that he had developed AHL in his brain, Dr Vinit Suri, Senior Consultant, Neurosciences at Apollo told IANS.
“Generally, patients wake up within a few hours after removing sedatives. However, when this patient did not move his limbs even after several hours, it alarmed us. The MRI scan of the patient’s brain showed a lot of swelling into the brain and an unusually large number of small bleeding spots called microhaemorrhages,” he said.
“Usually, when patients with a chest condition are removed from sedation and muscle relaxants (after being on a ventilator), they come back to consciousness within hours, but that was not the case with this patient. His MRI revealed that there were multiple swellings in the brain along with over 400 micro blood clots (haemorrhagic spots),” Suri added.
However, with a treatment through immunotherapy and steroids, the patient regained consciousness within 7 days. “He started opening his eyes and moving his limbs. Initially he was quite delirious and in a confused state but with time, his brain achieved full consciousness. Fortunately we were able to diagnose this condition on time. While he still has slight weakness in his limbs, his post treatment MRI shows more than 50 per cent recovery,” he said.
The patient was discharged on Saturday.
Encephalitis causes inflammation in the brain and is manifested by epileptic seizures, fever and headache.
Suri said that the association of COVID-19 with encephalitis is rare and only few cases have been reported worldwide. It is not the virus that hits the brain but it is the immune response towards the virus that causes inflammation in the brain.
Dr Manjari Tripathi, Head, Department of Neurology, All India Institute of Medical Sciences (AIIMS) Delhi said that the autoimmune response of the body in COVID-19 has found to be precarious for the nervous system of the body.
“The brain is involved in Covid and patients are found suffering from hypoxia and encephalitis. There are cases where patients who were on ventilators, went into coma and never regained consciousness. The cytokine storm is manifesting several complications in the body and the neurological disorders are one of them,” she said.
Tripathi said that people need to be more cautious and wear masks all the time. “It’s a relief that cases are on the downwards trend but we must know that we should not become a threat to others. Mask is a must till we achieve zero cases,” she added.
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