Er zijn wereldwijd mensen die ernstige neurologische klachten of hersenletsel overhielden na ziek te zijn geweest van COVID-19. Niet alle mensen met COVID-19 houden deze lange termijn klachten over, maar het kan wel voorkomen. We hebben een aparte pagina over hersenletsel en corona, met info of mensen met hersenletsel kwetsbaarder zijn.
Lees ook onze specifieke pagina over het Post-COVID syndroom / Long COVID. Long staat hier voor langdurige klachten. Via deze link.

Een publicatie Neurology  16 november 2021:
Er zijn specifieke neurologische complicaties geassocieerd met de COVID-19-infectie.
Sommige van de mensen die in het ziekenhuis zijn opgenomen met COVID-19 kregen een CVA (beroerte) door trombose (stolsels), en er zijn patiënten die tijdens de acute fase hypercoaguleerbaarheid (stollingsstoornissen) hebben.

Er zijn enkele individuen die micro-vaatziekte ontwikkelen, in het bijzonder micro-bloedingen door de hersenen heen, op het grensgebied van grijze en witte stof.

30 tot 50% van de individuen die een  acute infectie met COVID-19 hadden, klagen over symptomen van de lange termijn. De meeste van deze symptomen zijn neurologisch van aard.

Deze manifestaties zijn van verschillende fenotypen met overlappende syndromen.

• Overwegend inspannings-intolerantie.
• Cognitieve- en stemmingsstoornissen.
• Sommigen van de patiënten hebben acute angst of een eerste begin van psychose.
• Er zijn anderen die dysautonomie (bloeddruk of hartslagproblemen +onwel worden) en sommige klassieke POTS als syndroom hebben.(postoraal orthostatisch tachycardie syndroom = extreme hartslagstijging bij opstaan of overeind komen.)
  
• Dan is er een vierde groep waarvan hun klachten lijken op fibromyalgie en andere pijnsyndromen.
• Ten slotte is er een kleinere groep personen die lijdt aan gehoorverlies, tinnitus (oorsuizen) en vestibulaire aandoeningen (evenwichtsproblemen).

_______________________________________

Uit een studie uit Wuhan bleek dat 36,4% van de opgenomen patiënten neurologische klachten had.

Er zijn ook mensen die juist alleen met neurologische klachten in het ziekenhuis kwamen en COVID-19 bleken te hebben, zonder typische COVID-19 klachten.

Nederlandse onderzoekers hebben ontdekt dat Corona 'het immuunsysteem in de hersenen op hol kan brengen'. Bij onderzoek bij hersenen van overleden mensen (obductie) bleken er meer 'hersenmacrofagen' in de hersenen te zien, van mensen die aan Covid-19 leden (de ziekte die door het coronavirus ontstaat) dan in gezonde hersenen. Hersenmacrofagen zijn primaire immuuncellen van het centrale zenuwstelsel en voeren permanente bewaking uit of er een infectie gaande is. Het grote aantal hersenmacrofagen toont aan dat het immuunsysteem op hol sloeg. De hersenmagrofagen zien er onder de microscoop uit als enorm veel bruine spikkels.

Een onderzoeker vertelde dat corona elke functie in de hersenen kan beïnvloeden: de zintuiglijke functies, de bewegingen, gevoel, geheugen en concentratie.

Neurologische ziektebeelden als complicatie van COVID-19:

• COVID-19-encefalopathie. Er lopen studies naar vormen van encefalopathie die direct te linken zijn aan het doormaken van COVID-19. Wij zullen info op deze site plaatsen zodra er meer kennis over is. Voorlopige info:
  https://www.frontiersin.org/articles/10.3389/fnins.2022.855868/full
• Herseninfarct: Bloedpropjes die in de longen of hersenen terecht kunnen komen. In de hersenen veroorzaken zij een herseninfarct. In de longen veroorzaken zij een longembolie. Het is een belangrijk gevolg van COVID-19 dat veel mensen  bloedpropjes krijgen.
• Hersenbloeding: Om de bloedpropjes tegen te gaan die door COVID-19 veroorzaakt worden, wordt de patiënt met antistollingsmiddel behandeld, maar dit kan in enkele gevallen een hersenbloeding veroorzaken.
• Virale encefalitis: een hersenontsteking veroorzaakt door een virus.
  https://www.nationalgeographic.co.uk/science-and-technology/2021/08/how-does-covid-19-affect-the-brain-a-troubling-picture-emerges
• Virale encefalopathie: een zeldzame complicatie van griep (influenza) en andere virale infecties (zoals het coronavirus) is een acute necrotiserende encefalopathie. Necrotiserend betekent dat hersencellen afsterven. Encefalopathie is een verminderd functioneren van de hersenen.
• Wittestofafwijkingen in subcorticale frontale (voorhoofdskwab) en pariëtale kwabben (wandbeenkwabben). Zie onderzoek link
• Post anoxische encefalopathie (hypoxic-ischemic brain injury): Door zuurstoftekort werken hersenen verminderd goed.
• Mogelijk (dat verband wordt vermoed en onderzocht) de ziekte van Alzheimer en Parkinson, wat bleek na besmetting met het SARS virus in 2003. Het MERS virus ( MERS-CoV) veroorzaakte hersenontstekingen, en auto-immuunziektes. COVID-19 geeft een sterke reactie van het afweersysteem. Daardoor gaat het lichaam cytokines produceren (cytokinestorm), wat voor een ontsteking zorgt.

Neurologische en neuropsychologische gevolgen genoemd na een coronabesmetting / COVID-19:

• Neurofatigue, de beruchte hersenmoeheid
• Cognitieve klachten, brain-fog (hersenmist) moeite met denken, moeite met onthouden ( vergeetachtigheid), moeite met multitasking etc.
• Zintuiglijke overprikkeling
• Spraakproblemen, afasie, woordvindingsproblemen
• Verminderde reuk en smaak  / reuk- en smaakverlies (anosmie)
• Hoofdpijn
• Alle andere zichtbare en onzichtbare gevolgen van hersenletsel
• Guillain-Barré klachten (Het Guillain-Barré-syndroom is een neurologische aandoening waarbij het immuunsysteem op een infectie reageert en per ongeluk zenuwcellen aanvalt, wat resulteert in spierzwakte en uiteindelijk verlamming)
• Post Intensive Care symptomen na opname op IC. (PICS; zie alinea verderop)
• Delier
• Een onderzoek uit voorjaar 2023, toonde een opvallende hypoperfusie (niet goede doorbloeding) in een wijdverbreid cerebraal (grote hersenen) netwerk in de groep mensen met post-COVID-19, voornamelijk in de frontale cortex (frontale hersenschors), evenals de pariëtale (wandbeenkwab-schors) en temporale cortex (slaapkwab schors). De hypoperfusiegebieden geïdentificeerd in de regio's van de RECHTERHERSENHELFT waren uitgebreider. Deze bevindingen ondersteunen de hypothese van een grote netwerkdisfunctie bij post-COVID-patiënten met cognitieve klachten.

Neurologische klachten bij opname (NIET- typische COVID-19 klachten)

Er zijn wereldwijd mensen opgenomen in ziekenhuizen zonder specifieke COVID-19 klachten met griepsymptomen als hoesten of koorts, maar ze hadden wel typische neurologische klachten.

1. (hoofdpijn, duizeligheid, verminderd bewustzijn, ataxie, acute  beroerte/ CVA en epilepsie)
2. verminderd vermogen om dingen te proeven (hypogeusie), verminderd vermogen om te ruiken en om geuren te detecteren (hyposmie) en zenuwpijn/ neuropathische pijn (neuralgie)
3. skeletspiersymptomen.

Toen deze patiënten getest werden, bleken ze wel Covid-19 te hebben. In zeldzame gevallen lijkt het er op dat het cornavirus rechtstreeks de hersenen binnen kan dringen, zegt dr. Elissa Fory, een neuroloog bij Henry Ford Health System.

Genoemde klachten (niet bij allen dezelfde klachten):

• Bewustzijnsstoornissen / bewustzijnsveranderingen variërend van slaperigheid tot coma
• Verwarring
• Delier
• Hallucinaties (zie ook delier)
• Hoofdpijn
• Moeite met praten
• Duizeligheid
• Ataxie (verstoring van de coördinatie van bewegingen)
• Encefalopathie symptomen
• Encefalitis (hersenontsteking) symptomen
• Epileptische activiteit variërend van lichte afwezigheid, het maken van herhalende niet-doelbewuste bewegingen of een mentale statusverandering, waarbij mensen gewoon niet zichzelf zijn, tot zwaardere aanvallen.

SARS-CoV-2, het coronavirus dat COVID-19 veroorzaakt, kan neurologische aandoeningen veroorzaken door directe infectie van de hersenen of als gevolg van de sterke activering van het immuunsysteem. Het virus kan de bloed-hersenbarrière doorbreken.

PICS
Naast de cognitieve klachten door hersenschade, kunnen klachten ook ontstaan zijn door het Post intensive care syndroom (PICS). Nieuwe of verergerde klachten die ontstaan ten gevolge van een kritieke ziekte en de intensive care behandeling.

• Lichamelijke klachten (moeheid, verworven spierzwakte, slikstoornis, conditieverlies, kortademigheid)
• Cognitieve klachten als verminderde aandacht en concentratie
• Psychische problemen (angst, PTSS, depressie)
• Prikkelgevoeligheid

Partners, familieleden en andere naasten kunnen ook PICS ontwikkelen, dat wordt het Post Intensive Care Syndroom Familie genoemd, of PICS-F.
Lees meer.

Check

Als je twijfelt of jij hersenletsel of cognitieve klachten overgehouden hebt aan de coronabesmetting, dan kan je een checklist NAH invullen. NAH staat voor Niet-Aangeboren Hersenletsel, dus later in het leven opgelopen hersenschade.

Lees onze specifieke pagina over het Post-COVID syndroom / Long COVID Long staat voor langdurige klachten. Via deze link.

Lotgenotencontact

De Nederlandse facebookgroep ‘Corona patiënten met langdurige klachten’ heeft bijna 18 duizend leden.

Onderzoeken over langdurige (neurologische of hersenletsel) klachten nadat iemand Covid-19 heeft doorgemaakt

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https://www.bmj.com/coronavirus

https://www.nejm.org/coronavirus?query=main_nav_lg

https://jamanetwork.com/journals/jama/pages/coronavirus-alert

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