Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions

Abstract

Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10848-4.

Neurological Consequences, Mental Health, Physical Care, and Appropriate Nutrition in Long-COVID-19

“…The evaluation of neurological manifestations in post-acute COVID-19 disease can be explained by the different populations taken as samples to address the problem. The COVID-19 is a very new disease and, at present, incomplete knowledge of the mechanism of infection and the complexity of viral and non-viral factors involved in the disease explain the incomplete information on the effects of the SASR-CoV-2 virus on the nervous system (Beghi et al 2022 ). Although the main symptoms of COVID affect the respiratory system, acute and subacute neurological manifestations during the infection have been described in over 35% of cases (Nolen et al 2022 ).…”

Effects of vaccination, new SARS-CoV-2 variants and reinfections on post-COVID-19 complications

“…Also, it was discovered there are some factors related to acute COVID-19 which are linked with the higher probability of occurrence of post-COVID-19 complications and their severity. The severity and higher probability of occurrence of long-lasting COVID-19-related disturbances were found to be positively associated with the following factors associated with acute COVID-19: some specific acute symptoms (11, 12), severity (13, 14), and long duration of acute COVID- 19 (11) and high viral load (15). Vaccination status was associated with a lower risk of exacerbation of post-COVID-19 complications and with lower severity (16,17).…”

An Overview of Neurological and Psychiatric Complications During Post-COVID Period: A Narrative Review

“…Clinical studies reported a high risk of N/P disorders in COVID-19 and post-COVID-19 patients and also found that their outcomes were positively associated with the severity of COVID-19. [8][9][10] These clinical manifestations occur due to the direct invasion of SARS-CoV-2 into the central nervous system (CNS), often complicated by systemic hypoxia, dysfunctional activity of the renin-angiotensin system and other relevant pathological changes. These changes may remain long term and persistently causing post-COVID-19 CNSrelated symptoms such as difficulties in memory, attention and focus, persistent headaches, lingering loss of sense of smell and taste, enduring muscle aches and chronic fatigue.…”