How does coronavirus infection affect nervous system? Home care tips for stroke patients

31-Oct-2020

Scientists are learning more and more about potential damage from COVID-19, the disease caused by the novel coronavirus or SARS-CoV-2. Perhaps, the evidence is surging on the diverse neurological presentations linked with COVID-19 as the virus continues to evolve. Scientists have warned that at least one in every 100 patients hospitalized with COVID-19 can suffer a stroke. The findings published in the International Journal of Stroke also warned that brain abnormalities are common in COVID-19 patients, adding any damage to the organ may be permanent. Researchers also reported that the SARS-CoV-2 virus might be more likely to cause thrombotic vascular events, including stroke, compared to other coronavirus and seasonal infectious diseases. On the occasion of World Stroke Day, celebrated on October 29, we talked to Dr Vishal Sehgal, an expert in the field of trauma and emergency medical care, and Medical Director at Portea Medical, to get a better insight into the link between COVID-19 and stroke, including how the virus can affect the entire nervous system of patients.

Dr Vishal Sehgal: COVID-19 is a highly infectious disease and it has been known to cause several co-morbid conditions in people suffering from other chronic diseases and ailments. It is primarily a respiratory infection causing cough and difficulty in breathing. However, the coronavirus is also known to cause development of microthrombi (small clots) which can enter the bloodstream and reach the brain causing a stroke. People of any age experiencing severe COVID-19 infection can be at risk of such a condition. However, there is no clear or established evidence to link the pandemic with a stroke. People without any symptoms or infections can also suffer from this problem. Hence, it is important to be alert about the symptoms such as experiencing extreme weakness or paralysis on one side of the body.

What are the possible neurological and neuropsychiatric complications of COVID-19?

Dr Vishal Sehgal: COVID-19 can potentially affect the entire nervous system of the infected people, including the brain, spinal cord and nerves, etc. Despite there being a lack of confirmed evidence, it has been commonly observed that patients suffering from severe pandemic infection experience hampering of brain functions and neurological damage and complications. The virus affects multiple organs such as the lung, kidney and heart. This can lead to a lack of oxygen or clotting in the brain, resulting in strokes or neurological disorders. Until now, COVID-19 management processes have focused on containing and curing pulmonary complications. But it is now being increasingly understood that the disease can cause acute and long-term neuropsychiatric complications leading to morbidity and lower life quality. The neural spread of the novel coronavirus has manifested in encephalopathy, behavioural changes, headaches, delirium and decline of the ability to control body movements - such effects depend on the severity of the infection.

What are the precautionary measures that individuals suffering from a stroke should take to help prevent another stroke?

Dr Vishal Sehgal: Stroke patients need to take all the standard precautions advised by various health bodies such as wearing a mask, social distancing and hygiene as well as sanitization steps. In addition, it is very important to remain adequately hydrated. Dehydration can cause blood to thicken and cause narrowing of blood vessels. Eventually, it can impact blood supply to the brain causing the risk of stroke.

Dr Vishal Sehgal: Stroke is a leading cause of mortality in India. Hence, rehabilitation and home management of stroke patients is a critical and long-term process that typically involves physical as well as occupational therapy.
1. In physical therapy, the survivors are trained to relearn their movements and tightening of muscles or joints is prevented. There is also a focus on the coordination of various limbs and balancing.
2. In occupational therapy, the individual is trained to develop and learn the skills necessary for carrying out daily life activities such as eating, drinking and dressing, etc.
3. There are a number of steps and precautions that one needs to take in managing a stroke survivor at home. Neuro-rehab of a patient involves the usage of splints to control pain, hypotension and spasticity, etc.
4. The caregiver needs to be well versed with all knowledge related to the splints.
5. Pillows have to be placed carefully while the patient is lying or sitting and the shoulder needs careful handling as dislocation is quite likely.
6. There has to be complete adherence to safety precautions to prevent falls during the rehabilitation stage. Patients and their caregivers need to work on the strength of the patient especially in weaker limbs and guiding them on correct postures.

Last but not the least, it is important to modify the home to make it convenient and safe for the stroke survivors by taking measures such as the installation of railings on stairways, handle-bars, non-skid mats and height adjusted toilet seats. Fatigue can impact motor performance and therefore, intermittent rest is crucial.