Thread by @WesElyMD

1/ 🧵 What is “Brain Fog” in #COVID19: discussion, papers & pts
 Brain Fog is a non-medical term but it works since it’s what pts describe. Whether in a ward, ICU on a vent, or months later as a #LongHauler w #LongCOVID, they are “in a fog.”

bit.ly/3vMZ2ui

#medtwitter

2/ Medically this is #Delirium acutely and #Dementia chronically + various forms of neuropsychological impairment coupled with #depression and #PTSD.
 
Our paper: go.nature.com/3nU9ZYm

3/ Scientifically, it’s millions of neurons sick, dying or dead. This is depersonalizing & devastating. Fig A shows MRI 3 mos after ICU in pt w/out delirium vs B shows ICU pt w #Delirium. Duration of delirium predicted loss of 🧠 tissue.

Our MRI study - bit.ly/3uxAqFQ

4/ Most brain 🧠 loss following #CriticalCare time is from our frontal lobes & hippocampus, which causes problems with executive function & memory problems. See this previously normal person’s new inability to draw the figure months into recovery.

Paper: bit.ly/3o0l6PA

5/ In #COVID this goes by terms like PACS & PICS (post-acute #COVID syndrome & post-intensive care syndrome). These “worst case” pts are part of the spectrum of brain fog we see in #LongCovid.

6/ One of the #COVID19 pts in @doctor_oxford’s book Breathtaking about @NHS & the #Pandemic is Ken Wood. 2 wks into his ICU experience she writes: “From the moment he was sedated & placed on a ventilator…
 
amzn.to/3eYgXaM

7/ @doctor_oxford continues… “Ken has inhabited a lurid world of visions, nightmares, and hallucinatory horror. His brain is running amok.” This #Delirium is caused by the #COVID virus plus other things shown on my F-COVID slide below.

8/ We studied >2,000 #COVID pts & found they suffered ~2 WEEKS of coma/delirium, an epidemic within our pandemic. @LancetRespirMed published our COVID-D study: overuse of benzodiazepines and underuse of family were the main culprits – BOTH modifiable!
 
bit.ly/3vQ7SaF

8/ This severe acute brain fog is sometimes very harsh. Last week I was rounding in the afternoon with a stellar PA, Ann Marie Harrington at @VUMCLung (pic shown with her permission), and our intubated, delirious patient erupted in his bed, trying to jump out…

9/ Ms. Harrington and I didn’t even have PPE on other than our N95s and goggles. Reflexively and courageously, she bolted into the room and pushed him back down in the bed. There we held him until #nursehero could help calm him.

10/ I am sure that his #COVID19 brain fog made him think we were trying to hurt him or even kill him, when we were there to protect him. The PA bravely did something loving for him that was (we later learned) perceived as unloving. How often that happens in life.

11/ We must face hard truths about #LongCovid in the months & years of recovery ahead. Ask @Dr2NisreenAlwan - ongoing brain fog, which shifts from delirium early & into a dementia-like illness later, is fraught w landmines for family, care givers, and most of all…patients.

12/fin
#LongCovid brain fog will require patience, hard work, cognitive rehabilitation, rest, counseling, adjustment to a new normal. Anticipating a new #qualityoflife will help bridge the gap between former self & new self, hopefully increasing acceptance & serenity. Get ready!