Brain Injury Awareness Month: Neurosurgeon Explains How COVID-19 Affects Brain And Tips To Manage It

Brain Injury Awareness Month 2021: As COVID-19 (coronavirus) continues to spread far and wide across the world, there are many concerns about health and safety. While corona is primarily a respiratory disease, it affects other organs as well, including the brain. Patients with the disease present a host of effects on the brain that range in austerity from confusion to loss of taste and smell and, at times, life-threatening strokes, which can lead to long term neurological issues. While researchers are yet to unravel the mysteries of the effects of the infection on the brain, they have several theories, but each needs to be studied rigorously before any conclusions can be made. How brain injury occurs? In addition to vehicle accidents, injuries during sports and falling from a height are also the main reason for this. It can occur at any time and to anyone; also, it can cause brain damage. Damage to the brain occurs when the head bounces or turns due to a sudden jerk in the head, causing a stretch in the brain cells, internal injury, and chemical changes, disrupting normal brain functions.

What is the impact of TBI (Traumatic Brain Injury)?

Not necessarily the result of all injuries to the head in the form of TBI. But when this happens, TBIs can range from mild (such as a favourable change in mental state or consciousness) to severe (such as fainting long after an injury or problems in thinking and behaviour). Brain trauma is also a form of mild TBI. Children with traumatic brain injury have an increased risk of neuropsychiatric disorder. Researchers have found that children with traumatic brain injury have a chance of headache, depression, and mental or intellectual disorders for up to five years of the damage.

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• Sudden infection: The first theory proposed by researchers suggests the virus may have the capacity to enter the brain and bring about a sudden and severe infection. There have been cases where the virus’s genetic material and viral particles have been found in spinal fluid and brain cells due to the virus entering the bloodstream or nerve endings. The loss of smell found in some patients with COVID-19 could indicate that the virus entered via the olfactory bulb located right above the nose, carrying out information about the smell to the brain.
• Abnormalities with blood-clotting: The fourth way the virus might cause brain damage is linked to these patients' tendency to suffer a stroke. Patients suffering from Covid-19 have a highly abnormal blood clotting mechanism and are more likely to suffer from clots than other patients. When formed deep inside the body or in the lungs, clots can cut off blood, and a stroke could happen if a blood clot were to narrow or block arteries leading to the brain.

• Maladaptive” inflammatory response: The second theory floated out states the possibility of the immune system going into overdrive in an attempt to fight COVID-19, thereby producing a “maladaptive” inflammatory response that may cause the majority of the organ and tissue injury observed in this condition — conceivably more than the virus itself.
• Multiple effects on the Body: The third theory believes that all of the physiological changes brought about in the body during the infections, including high fevers, low oxygen levels and multiple organ failures contribute to or account for brain dysfunction, such as delirium or coma seen in many severe COVID-19 patients.

Effects on the brain

Corona infection has been found to affect the brain in more ways than one, including:

• Trouble focusing on things at hand
• Loss of smell and taste
• Loss of consciousness
• Changes in behaviour
• Headaches
• Confusion
• Seizures
• Stroke

In addition to the above, patients are also known to suffer from peripheral nerve issues such as Guillain-Barré syndrome, leading to paralysis and respiratory failure.

Also read: Obesity Linked to Traumatic Brain Injury

Exploring the unknown side of brain injury awareness and COVID-19

• The more we learn about the COVID-19/coronavirus, the more insidious it seems to be, and while full consideration has been given to the number of lives that we have lost so far and how to protect the society and keep it functioning. Simultaneously, the pandemic rages on, it is also essential to take a hard look at how to serve those who survive the infection but at a price - sustained cognitive impairment. Ongoing research reveals that in addition to the effects of the virus on pulmonary systems has devastating short- and long-term mental effects for some survivors, which includes brain damage at the end.
• COVID-19 can increase the risk for stroke even in youthful, formerly healthy survivors and acquired brain injury is commonly the result of a stroke. Besides the expected side, the effect ranges from less severe problems like loss of smell (a disruption in the neurons involved in the olfactory system) to the ones that seriously disrupt one’s quality of life, like the inability to regulate one’s blood pressure. Other symptoms present due to the attack on the body’s central nervous system by the virus include headaches, dizziness, cerebrovascular disease, epilepsy, encephalopathy or ataxia (losing control of bodily functions). The survivors often describe “brain fog,” a condition that presents as not being able to think straight, and the patients are quickly exhausted or fumble for the right words in recovery.
• Furthermore, it has been reported that one-third of patients suffering from acute respiratory failure due to Covid also experience cognitive impairment as compared to that seen in a moderate traumatic brain injury. This includes losing brain function leading to difficulties tracking daily responsibilities, understanding the written word, and communicating verbally. A recent study even suggests that patients who recover from the virus suffer brain decline, with the worst cases having the potential of effectively ageing a brain by ten years.

• Amid rising Covid-19 cases, the international brain injury association encourages all individuals with brain injury to get vaccinated to avoid additional neuroinflammatory issues and keep themselves, their families, and their communities safe.
• The virus is known to attack the weakest link in the body, and for this reason, individuals with longstanding chronic medical issues are at the most significant risk for infection, complications, and even death.
• Researches have revealed that patients with traumatic brain damage/injury experience chronic problems due to the brain's inflammatory processes. Other places those individuals at a greater risk of developing complications from COVID-19, which itself is well known to cause chronic neuroinflammatory issues.

Conclusion

In daily life, we get various kinds of injuries. Some injuries prove to be quite harmful over time. The brain is part of the body where there can be a lot of damage to the injury. Brain injuries in accidents, i.e. Traumatic Brain Injury (TBI), is a significant health problem in India, mostly affected by working young and active people. Due to these, they are injured or suffering a disability, so many cases of death are also being seen. According to some reports, every year, 15 to 20 lakh people in India get serious head injuries, and more than one lakh 20 thousand people die. More than 60 per cent of TBI cases are due to road traffic accidents.

References: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

(Inputs By Dr Amit Dhakoji, Consultant-Neurosurgeon, Jupiter Hospital, Pune)

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