Neurological consequences of COVID-19: what have we learned and where do we go from here?

Abstract

The coronavirus disease-19 (COVID-19) pandemic is an unprecedented worldwide health crisis. COVID-19 is caused by SARS-CoV-2, a highly infectious pathogen that is genetically similar to SARS-CoV. Similar to other recent coronavirus outbreaks, including SARS and MERS, SARS-CoV-2 infected patients typically present with fever, dry cough, fatigue, and lower respiratory system dysfunction, including high rates of pneumonia and acute respiratory distress syndrome (ARDS); however, a rapidly accumulating set of clinical studies revealed atypical symptoms of COVID-19 that involve neurological signs, including headaches, anosmia, nausea, dysgeusia, damage to respiratory centers, and cerebral infarction. These unexpected findings may provide important clues regarding the pathological sequela of SARS-CoV-2 infection. Moreover, no efficacious therapies or vaccines are currently available, complicating the clinical management of COVID-19 patients and emphasizing the public health need for controlled, hypothesis-driven experimental studies to provide a framework for therapeutic development. In this mini-review, we summarize the current body of literature regarding the central nervous system (CNS) effects of SARS-CoV-2 and discuss several potential targets for therapeutic development to reduce neurological consequences in COVID-19 patients.

Neurological Consequences of SARS-CoV-2 Infection and Concurrence of Treatment-Induced Neuropsychiatric Adverse Events in COVID-19 Patients: Navigating the Uncharted

“…Similarly, corticosteroids can provoke agitation, anxiety, depression, delusion, and hallucinations ( Ou et al, 2018 ). Both corticosteroids and anti-viral drugs may also trigger convulsions and seizures ( van Campen et al, 2018 ; Jarrahi et al, 2020 ). Apart from these, the potential COVID-19 therapies may also interact with the prescribed medications for pre- and/or co-existing neuropsychiatric diseases demonstrating serious drug-drug interactions, thereby, further complicating the clinical outcomes.…”

Brief psychotic disorder associated with quarantine and mild COVID-19

“…Immune mechanisms have been implicated in the pathogenesis of psychiatric disorders including schizophrenia 21 and COVID-19 is associated with inflammation. 13 The patient’s CRP and ferritin, peripheral inflammatory markers, were both elevated during his illness making it possible that inflammatory processes were involved. The elevated CRP was recorded shortly before he became psychotic and contrasted to normal assays at admission and discharge and during his period of psychosis.…”

“… 13 Other coronaviruses, including SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), are known to be neurotropic. 13 In support of this possibility, SARS-CoV-2 RNA had been detected in the cerebrospinal fluid of patients with neuropsychiatric complications of COVID-19 including encephalitis 14 and meningitis. 15 However, at present, such cases appear rare.…”

Infections of the lung: a predictive, preventive and personalized perspective through the lens of evolution, the emergence of SARS-CoV-2 and its pathogenesis

“…Given this progression, the swift pathological release of excessive amount of cytokines, termed as "cytokine storm" and is concomitant to high fever, respiratory distress, multi-organ failure, and increased mortality in COVID-19 patients [129,130,137]. Clinically, the cytokine storm associated with acute respiratory distress syndrome (ARDS) is the leading cause of mortality in severe cases of some respiratory viral infections, including COVID-19 [138,139]. The anti-inflammatory treatment such as cannabidiol (CBD) has shown to reduce cytokine storm and to reverse the symptoms of ARDS in acute phase of lung infection relevant to COVID-19 [139,140].…”