journal

1. A study of neurological complications in
hospitalised COVID 19 patients, admitted in
DR B.R.Ambedkar medical college and
hospital,Bengaluru.
Guide : DR Vishnu Hayagreev
Presentor :DR Raghavendra Gangaraddi

2. NEED FOR THE STUDY
• The novel coronavirus 2019 has gripped the world like none other in
recent times. It is pandemic of enormous propotions,bound to create a
lasting impact on mankind,significant enough to classify the 21st century
into pre COVID era,an eventful COVID era,and yet to come and evolving
post COVID era.
• Though the fear, anxiety, and stress related to COVID-19 have been
studied in depth, the direct effects of SARS-CoV-2 on the central nervous
system (CNS) remain elusive.
• Research related to the earlier coronavirus (CoV) outbreaks (like Severe
Acute Respiratory Syndrome, SARS and Middle East Respiratory
Syndrome, MERS) shows the neurotropic nature of CoV and the plethora
of neuropsychiatric effects that it can cause.

3. • Though the current health priorities in managing COVID-19 remain
restricted to containment and targeting pulmonary symptoms, the
potential acute and long-term neuropsychiatric sequelae of the infection
can increase morbidity and worsen the quality of life.
• Emerging evidence shows neural spread of the novel coronavirus.
Delirium, encephalopathy, olfactory disturbances, acute behavioral
changes, headache and cerebrovascular accidents are its common
neuropsychiatric complications. These are directly related to increase in
peripheral immunological markers, severity of infection and case fatality
rate.
• This narrative review synthesizes available evidence related to the
neuropsychiatric manifestations of COVID-19. Also, as SARS-CoV-2
shares structural and functional similarities with its earlier congeners, this
article proposes possible long-term neuropsychological sequelae and
pathogenic mechanisms for the same, based on research in the other
coronavirus outbreaks.

4. Aims and objectives
•To study neurological complications in hospitalised Covid
19 patients,admitted in DR B.R.Ambedkar medical college
and hospital,Bengaluru.

5. CRIETERIA
• Gender
• Age
• Socioeconomic status
• Religion
• Time of onset of symptoms
• Time of testing
• With/without oxygen
• With/without ventilator
• Organ damage
• Co-morbidities
• Habbits

6. • On any medications.
• Number of days of admission.
• Advice on discharge.

7. Pathogenesis
Direct injury (Blood circulation)
• Exaggerated immune response
• Cytokines increasing blood-brain-barrier (BBB)
permeability
Causes
• Encephalopathy
• Delirium and acute confusional state
.

8. Dysregulated immunomodulation
• Cytokine storm (surge of peripheral IL-6,8,10,18, TNF-alpha, etc.)
• Systemic Inflammatory Response Syndrome (SIRS)
• Upregulation of oligodendrocytes and astrocytes (increased release of IL-
15, TNF-alpha)
• Leaky BBB
• Disturbed neurotransmission
causes
• Encephalitis
• MODS

9. Direct injury (Neuronal route)
• Predilection for olfactory epithelium, bulb and vagal centers
• Anterograde and retrograde neural proliferation via dynein and
kinesin
• Structural preference for the forebrain, basal ganglia and
hypothalamus
causes
• Anosmia
• Dysguesia
• Psychiatric disorders

10. Hypoxic injury
• Impaired pulmonary exchange and pulmonary oedema can cause
cerebral hypoxia
• Cerebral oedema, vasodilation, ischaemia and vascular congestion
• Increased intracranial pressure
causes
• Encephalopathy
• Somnolence
• Coma
• Headache
• Confusion

11. Materials and methods
• Clinical,lab investigations,treatment and outcomes were
obtained with data collection forms from electronic medical
records and history given by 200 covid-19 infected patients
admitted in COVID-19 block of DR.B.R.Ambedkar medical
college and hospital,Bengaluru,karnataka
• Study design:Retrospective Observational study.

12. SAMPLE SIZE
• 200 patients ,aged more than 18 years were enrolled for
study.
STUDY PERIOD

13. STUDY PERIOD
• From 2020 JULY 1ST upto NOVEMBER 30,2020.

14. INCLUSION CRITERIA
• Age group>18years.
• Hospitalised with laboratory confirmed RT-PCR
positive COVID-19 infected patients
CLINICAL CASE DEFINITIONS:
- Cerebrovascular event(defined as acute
ischaemic,hemorrhagic,or thrombotic vascular event
involving brain parenchyma or subarachnoid
hemorrhage).

15. - Altered mental status(defined as an acute alteration in
personality,behaviour,cognition or consciousness).
- Peripheral neuropathy
- Bells palsy.

16. EXLUSION CRITERIA
• Age group <18yrs
• Patients with pre-covid 19 infection neuropsychiatric
manifestations.
• Pregnancy.
• Patients not willing for study.
• Known CKD
• Patients on sedatives.

17. INVESTIGATIONS AND PARAMETERS
• CBC
• RFT
• LFT
• ABG ANALYSIS
• SERUM ELECTROLYTES
• RBS
• CT BRAIN PLAIN(AS AND WHEN NECESSARY)

18. THANK YOU