Central nervous system complications in SARS-CoV-2-infected patients

Abstract

Objective To investigate the clinical manifestations, treatment and prognosis of COVID-19-associated central nervous system (CNS) complications. Methods In this single-centre observation study, we recruited patients with COVID-19-associated CNS complications at the neurology inpatient department of the Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen) from Dec 2022 to Feb 2023. Patients were analysed for demographics, clinical manifestations, cerebrospinal fluid properties, electroencephalographic features, neuroimaging characteristics, and treatment outcome. All patients were followed-up at 1 and 2 months after discharge until Apr 2023. Results Of the 12 patients with COVID-19-associated CNS complications, the CNS symptoms occur between 0 days and 4 weeks after SARS-CoV-2 infection. The most common CNS symptoms were memory deficits (4/12, 33%), Unresponsiveness (4/12, 33%), mental and behavioural disorders (4/12, 33%). Seven of 12 cases can be categorized as probable SARS-CoV-2 encephalitis, and 5 cases can be described as brainstem encephalitis, acute disseminated encephalomyelitis, optic neuritis, multiple sclerosis or tremor probably associated with SARS-CoV-2 infection. Six patients received antiviral therapy, and 11 patients received glucocorticoid therapy, of which 3 patients received human immunoglobulin synchronously. Nine patients recovered well, two patients had residual neurological dysfunction, and one patient passed away from complications associated with tumor. Conclusion In this observational study, we found that the inflammatory or immune-related complications were relatively common manifestations of COVID-19-associated CNS complications, including different phenotypes of encephalitis and CNS inflammatory demyelinating diseases. Most patients recovered well, but a few patients had significant neurological dysfunctions remaining.

CRP/Neopterin Ratio and Neuropsychiatric Symptoms in Patients with Different Forms of Pneumonia: Results of a Pilot Study

“…Also, neurological symptoms, such as headaches and smell or taste disorders, were observed significantly more often in COVID-19 patients compared to Influenza -infected patients. Several studies have proposed/shown that SARS-CoV-2 also affects the nervous system [ 31 , 35 , 36 ] and might affect brain function by inducing neuroinflammatory cascades.…”

Mast cell activation triggered by SARS-CoV-2 causes inflammation in brain microvascular endothelial cells and microglia

“…SARS-CoV-2 may enter brain by crossing neural-mucosal interface in olfactory mucosa or via the gustatory-olfactory trigeminal pathway ( Jiao et al., 2021 ; Meinhardt et al., 2021 ; Beckman et al., 2022 ; Frank et al., 2022 ). The induction of excessive neuroinflammation has been reported to be a critical pathogenetic factor ( Frank et al., 2022 ; Chaves-Filho et al., 2023 ; Ousseiran et al., 2023 ; Theoharides and Kempuraj, 2023 ; Li et al., 2023a , Li et al., 2023b ). The neurovascular inflammation leads to the damage of blood–brain barrier (BBB), and the neuron hypoxic-ischemic injury and neuron degeneration ( Bodnar et al., 2021 ; Lee et al., 2021 ; Meinhardt et al., 2021 ; Adesse et al., 2022 ; Beckman et al., 2022 ; Frank et al., 2022 ; Rutkai et al., 2022 ).…”