A Systematic Review of Neurological Manifestations of COVID-19

Magar, Sumeru Thapa; Lokhandwala, Hatim I; Batool, Saima; Zahoor, Faiqa; Zaidi, Syeda Kisa Fatima; Sahtiya, Saveeta; Khemani, Deepa; Kumar, Sumeet; Voloshyna, Diana; Saleem, Faraz; Ghaffari, Muhammad Abu Zar

doi:10.7759/cureus.28309

Cited by 3 publications

(3 citation statements)

References 40 publications

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“…Several studies have reported frequently occurring NNM linked to COVID-19. 11,12,21,22 A study by Thapa Magar et al, 21 in a sample of 3055 COVID-19 patients also documented a preponderance of similar NNM as observed in our setting, with fatigue (32%), myalgia (20%), smell and taste impairment (21%), and headache (19%) most frequently observed.…”

Section: Discussionsupporting

confidence: 85%

“…Other studies have included fatigue under NNM, which we conceptualised as a constitutional symptom. 21 Researchers also found that patients without NNM were more likely to have respiratory symptoms, although there was only a trend towards significance. It was postulated, and confirmed, that URT symptoms were associated with the NNM loss of smell and/or taste as infection and inflammation in URT tissues would also be more likely to influence taste and smell.…”

Section: Discussionmentioning

confidence: 99%

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Neurological and neuropsychiatric manifestations in hospitalised patients with COVID-19

Lekpeh,

Salie,

van den Heuvel

et al. 2023

South African Journal of Psychiatry

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Background: Although literature globally indicates varied neurological and/or neuropsychiatric manifestations (NNM) and complications associated with coronavirus disease 2019 (COVID-19), information about NNM in infected hospitalised patients on the African continent remains limited.Aim: To describe the presentation of NNM and compare patients with and without NNM considering demographic and clinical profiles, treatment, and outcomes.Setting: Tygerberg Hospital, Cape Town, South Africa.Methods: Retrospective medical record review of the first 100 consecutively admitted COVID-19 patients (64 females, mean age 47.6 years) between March and June 2020.Results: Of the 98 patients included in the analysis, 56.1% had at least one NNM. The most common NNM were myalgia (32.7%), headache (21.4%), loss of smell and/or taste (15.3%), and delirium (10.2%). Patients with and without NNM did not differ with respect to demographic characteristics. Patients with NNM had significantly more constitutional symptoms (p = 0.017) and were more likely to have neurological and/or neuropsychiatric comorbid conditions (10.9% vs. 0.0%, p = 0.033) than those without NNM. Patients without documented NNM were more likely to have abnormalities on chest X-ray (p = 0.009) than those with NNM. Coronavirus disease 2019 related treatment and mortality did not differ between the groups.Conclusion: Neurological and/or neuropsychiatric manifestations were common in hospitalised patients with COVID-19. The results suggest that while COVID-19 patients with NNM may have less of a respiratory phenotype they nonetheless have equivalent mortality rates.Contribution: This study highlights the common NNM in patients with COVID-19 admitted to Tygerberg Hospital early in the pandemic and adds to the growing evidence of COVID-19 NNM.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Neurological and neuropsychiatric manifestations in hospitalised patients with COVID-19

Lekpeh,

Salie,

van den Heuvel

et al. 2023

South African Journal of Psychiatry

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“…The coronavirus disease 2019 (COVID-19) pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which has continuously evolved and mutated into a range of variants with differing transmission and pathogenesis characteristics [ 1 ]. One approach to help understand acute and long-term sequelae associated with SARS-CoV-2 infection, particularly the neurological consequences [ 2 ], is to investigate the complex binding interactions of the SARS-CoV-2 virus with various receptors in the human body.…”

Section: Introductionmentioning

confidence: 99%

The SARS-CoV-2 Virus and the Cholinergic System: Spike Protein Interaction with Human Nicotinic Acetylcholine Receptors and the Nicotinic Agonist Varenicline

Carlson¹,

Macsai²,

Bertrand

et al. 2023

IJMS

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the worldwide coronavirus disease 2019 (COVID-19) pandemic. Although the pathophysiology of SARS-CoV-2 infection is still being elucidated, the nicotinic cholinergic system may play a role. To evaluate the interaction of the SARS-CoV-2 virus with human nicotinic acetylcholine receptors (nAChRs), we assessed the in vitro interaction of the spike protein of the SARS-CoV-2 virus with various subunits of nAChRs. Electrophysiology recordings were conducted at α4β2, α3β4, α3α5β4, α4α6β2, and α7 neuronal nAChRs expressed in Xenopus oocytes. In cells expressing the α4β2 or α4α6β2 nAChRs, exposure to the 1 µg/mL Spike-RBD protein caused a marked reduction of the current amplitude; effects at the α3α5β4 receptor were equivocal and effects at the α3β4 and α7 receptors were absent. Overall, the spike protein of the SARS-CoV-2 virus can interact with select nAChRs, namely the α4β2 and/or α4α6β2 subtypes, likely at an allosteric binding site. The nAChR agonist varenicline has the potential to interact with Spike-RBD and form a complex that may interfere with spike function, although this effect appears to have been lost with the omicron mutation. These results help understand nAChR’s involvement with acute and long-term sequelae associated with COVID-19, especially within the central nervous system.

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Overcoming Infections Including COVID-19, by Maintaining Circulating 25(OH)D Concentrations Above 50 ng/mL

Wimalawansa¹

2022

PLMI

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The elderly and those with underlying chronic diseases (i.e., comorbidities) such as pulmonary, cardiovascular, metabolic, and renal diseases, increase their susceptibility to sepsis, including COVID-19. The SARS-CoV-2 virus damages pulmonary cells, causing acute respiratory distress syndrome (ARDS) and hypoxia. It further damages endothelial cells, altering clotting mechanisums causing intravascular hemolysis, microvascular thrombosis, and micro-embolization, contributing to the risk of death. Approximately 75% of the immune system functions of humans depend on vitamin D and the availability of sufficient amounts of vitamin D metabolites [vitamin D and 25(OH)D] concentrations to enter immune cells from the bloodstream. Such concentrations are achievable through sun exposure, targeted food fortification programs, and adequate daily or weekly vitamin D supplements. That would allow for generating 1,25(OH) 2 D (non-hormonal form of calcitriol) intracellularly in peripheral target cells like immune cells. This enables immune cells' physiological functions, including intracrine/autocrine and paracrine signaling processes. This initiates and maintains robust immune functions, such as forming antibodies and antimicrobial peptides, suppressing inflammation, and increasing the expression of anti-inflammatory and antioxidant genes, thus, strengthening immune functions. The opposite occurs in hypovitaminosis D, increasing vulnerability to infections and dying from it. Therefore, governments should make the population sufficient with immunoceuticals-micronutrients, especially vitamin D, and other micronutrients: the most cost-effective intervention to keep the population healthy. The cost of such interventions are minuscule compared to the expenses related to increased hospitalizations and premature deaths. Supposed such a program was implemented in mid-2020 as the author proposed, we estimated that 50% of hospitalizations (and the associated healthcare costs) and a third of deaths from COVID could have been prevented. Described herein are cost-effective strategies using vitamin D to achieve and sustain serum D 3 and 25(OH)D concentrations crucial for maintaining a robust immune system, improving general health, minimizing disease severities and deaths, and reducing healthcare costs.

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A Systematic Review of Neurological Manifestations of COVID-19

Cited by 3 publications

References 40 publications

Neurological and neuropsychiatric manifestations in hospitalised patients with COVID-19

Neurological and neuropsychiatric manifestations in hospitalised patients with COVID-19

The SARS-CoV-2 Virus and the Cholinergic System: Spike Protein Interaction with Human Nicotinic Acetylcholine Receptors and the Nicotinic Agonist Varenicline

Overcoming Infections Including COVID-19, by Maintaining Circulating 25(OH)D Concentrations Above 50 ng/mL

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