BBC medical correspondent Fergus Walsh met with NHNN patient Paul Mylrea, 64, who is making a remarkable recovery after suffering two major strokes triggered by COVID-19 infection.

Im very lucky in physical terms but it has been tough, said Paul who had previously been very healthy and active and had a passion for diving.

After my second stroke, my wife and daughters thought that was it, they would never see me again. The doctors told them there was not much they could do except wait. Then I somehow survived.

Pauls first stroke was caused by a blood clot in his brain and happened while he was recovering from COVID-19 at University College Hospital. The clinical team also found blood clots in his lungs and legs so prescribed powerful blood-thinning drugs.

A couple of days later, however, he suffered a second, even bigger stroke and was transferred to the NHNN for specialist care.

Pauls consultant neurologist, Dr Arvind Chandratheva, said: I immediately assumed the blood-thinning drugs had caused a bleed in the brain but what we discovered was unlike anything we have seen before.

Despite the blood-thinning treatment, Pauls second stroke had been caused by another clot in his brain and blood tests showed that he had extraordinarily high levels of a clotting marker called D-dimer. Normally these levels are less than 300 and can rise to 1,000 in stroke patients but in Pauls case they were 80,000.

"I've never seen that level of clotting before something about his body's response to the COVID-19 infection had caused his blood to become incredibly sticky," said Dr Chandratheva.

It puzzled us why a fit and healthy man had experienced so many blood clots in rapid succession, despite blood-thinning treatment. But in just two weeks in April 2020, our team saw six people with COVID-19 who had similar strokes caused by a blocked, large artery in the brain.

We were witnessing the unfolding of a distinctive pattern of stroke associated with the pandemic.

Specialists at the NHNN have also seen an increase in COVID-19 patients with extensive inflammation in the brain. They do not think this is caused by COVID-19 itself but by the bodys immune system overreacting to the disease.

Consultant neurologist Dr Michael Zandi said: We are starting to see a number of effects of COVID-19 on the brain which are very concerning. For some people it could be devastating and life-altering.

We need to be prepared for decades of impact on peoples brains and mental health. The closest comparison we have is the 1918 flu pandemic when a lot of brain disease and problems emerged over the following 10 to 20 years."

Paul, who is a leading communications professional and speaks six languages, spent five weeks in hospital but is now recovering extremely well at home.

In the BBC report, we see Paul having online neurorehabilitation with clinical psychologist Dr Catherine Doogan and occupational therapist Kate Kelly as part of the N-ROL programme. The programme is led by Professor Nick Ward and supported by fundraising efforts by the charity SameYou to allow people to continue with their rehabilitation at home during the pandemic.

Paul said: I have been getting progressively stronger thanks to the ongoing care of the NHNN.

Here is the full news report, online articleand podcast(at 22m 20s).

For further information also see an article featuring Dr Chandratheva in The Conversation.

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COVID-19 on the brain: BBC News at the National Hospital for Neurology and Neurosurgery - University College London Hospitals