Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists

Abstract

<jats:p>Coronavirus disease 2019 (COVID‐19) has become a pandemic disease globally. Although COVID-19 directly invades lungs, it also involves the nervous system. Therefore, patients with nervous system involvement as the presenting symptoms in the early stage of infection may easily be misdiagnosed and their treatment delayed. They become silent contagious sources or ‘virus spreaders’. In order to help neurologists to better understand the occurrence, development and prognosis, we have developed this consensus of prevention and management of COVID‐19. It can also assist other healthcare providers to be familiar with and recognise COVID-19 in their evaluation of patients in the clinic and hospital environment.</jats:p>

Clinical time course of COVID-19, its neurological manifestation and some thoughts on its management

“…If these neurological symptoms are present, test for COVID-19 may be warranted. 6 In our previous publication in JAMA Neurology, we retrospectively reviewed 214 patients with confirmed diagnosis of COVID-19. Among them, 88 (41%) were severe cases and 126 (59%) were mild.…”

Dealing with immune-mediated neuropathies during COVID-19 outbreak: practical recommendations from the task force of the Italian Society of Neurology (SIN), the Italian Society of Clinical Neurophysiology (SINC) and the Italian Peripheral Nervous System Association (ASNP)

“…dizziness, headache, impaired consciousness, ataxia and epilepsy), peripheral nervous system (i.e. taste, smell and vision impairment and neuralgia) and skeletal muscular damage [6,7]. It is also frequent to find a concomitant COVID-19 infection in patients presenting with acute neurological disorders including stroke and seizure [7].…”

Could COVID-19 represent a negative prognostic factor in patients with stroke?

“…Coronaviruses (CoVs), positive-stranded RNA viruses, are known to cause respiratory or intestinal infections in humans and animals. 1 Coronaviruses are known to affect the cardiovascular system. 2 The SARS-CoV-2 virus uses the enzyme 2 receptor (ACE2) to gain entry into cells, 3 and these receptors have been revealed in the neuronal and glial cells of the human brain.…”

“…Thus, they may be a potential target of SARS-CoV-2, which might explain the death of olfactory cells in patients with COVID-19. 1 CoVs can enter the central nervous system through 2 distinct pathways: retrograde neuronal diffusion or hematogenous diffusion. The spread of SARS-CoV-2 through the cribriform plaque of the ethmoid bone during an initial or subsequent infection phase can lead to brain involvement.…”

“…4,5 Several symptoms indicative of CNS involvement are present in approximately one-third of COVID-19 patients: dizziness, headache, impaired consciousness, ataxia, epilepsy, and acute cerebrovascular disease. 1 Changes in the coagulation system (ie, D-dimer and platelet abnormalities) 2,6 and in inflammatory biomarkers (eg, interleukin-6, C-reactive protein, and ferritin) 7 have been reported in COVID-19 patients. In patients with stroke, the presence of COVID-19 could be a potential extrinsic factor in the genesis or worsening of stroke.…”