Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

Abstract

The main focus of Coronavirus disease 2019 (COVID-19) infection is pulmonary complications through virus-related neurological manifestations, ranging from mild to severe, such as encephalitis, cerebral thrombosis, neurocognitive (dementia-like) syndrome, and delirium. The hospital screening procedures for quickly recognizing neurological manifestations of COVID-19 are often complicated by other coexisting symptoms and can be obscured by the deep sedation procedures required for critically ill patients. Here, we present two different case-reports of COVID-19 patients, describing neurological complications, diagnostic imaging such as olfactory bulb damage (a mild and unclear underestimated complication) and a severe and sudden thrombotic stroke complicated with hemorrhage with a low-level cytokine storm and respiratory symptom resolution. We discuss the possible mechanisms of virus entrance, together with the causes of COVID-19-related encephalitis, olfactory bulb damage, ischemic stroke, and intracranial hemorrhage.

A Systematic Review of Imaging Studies in Olfactory Dysfunction Secondary to COVID-19

“…Other findings on MRI included OB enhancement following gadolinium injection in 18/218 (8.25%) ( 5 , 7 , 8 , 28 ) and T2 hyperintensity in the OB/tract in 29/218 (13.30%) ( 4 , 10 , 12 , 17 , 18 , 19 , 20 , 21 , 26 ) ( Figure 3 A), while hypointense focus, consistent with microhemorrhage/methemoglobin deposition ( Figure 3 B), was identified in 17/218 (7.8%) ( 5 , 10 , 28 ). T2 hyperintensity in OB was detected in 11/80 (13.75%) and 18/85 (21.17%) during the early and late imaging, respectively.…”

“…The exact pathophysiology of COVID-19-induced anosmia is not fully understood ( 1 , 2 , 3 ). Various imaging modalities have been used to assess the olfactory dysfunction in COVID-19, mainly by imaging OB and OC, such as with magnetic resonance imaging (MRI) ( 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ), computed tomography (CT) of paranasal sinuses ( 29 , 30 , 31 , 32 ), or with functional modalities such as positron emission tomography (PET) of brain ( 15 , 22 , 33 ). These studies have reported a variety of findings, which are at times divergent.…”

Neurological Manifestations and Outcomes in a Retrospective Cohort of Mexican Inpatients with SARS-CoV-2 Pneumonia: Design of a Risk Profile

“…Solid epidemiological data have shown that patients with COVID-19 present with frequent and diverse neurological symptoms regardless of the level of clinical severity [12][13][14], and these symptoms occurred more frequently in persons with more severe systemic presentations [15]. Currently, hospitalized patients represent a minority of COVID-19-infected cases, due to both the lack of risk factors for severe disease in many sectors of the general population and the introduction of the vaccine for SARS-CoV-2; however, non-hospitalized patients may also develop sequelae following infection, including neurological symptoms [15][16][17][18][19]. Some of these symptoms could be due to the systemic inflammatory cascade documented in these patients termed as disorders related to the nervous system, such as myopathy, neuropathy, delirium, encephalopathy, and ACD [10], and are also known as neurological complications in patients with COVID-19.…”

Plasma Renin Concentration in Critically Ill COVID-19 Patients

“…Several biomarkers have been proposed for evaluating the clinical severity of patients with COVID-19 with respiratory or neurological symptoms, such as interleukin 6, ferritin and LDH, or angiopoietin levels [4,5]. However, their measurement is often not simple or easy to perform, or their accuracy is not entirely known, and many conditions can alter their values [6].…”