Neurological manifestations and implications of COVID-19 pandemic

Abstract

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China and rapidly spread worldwide, with a vast majority of confirmed cases presenting with respiratory symptoms. Potential neurological manifestations and their pathophysiological mechanisms have not been thoroughly established. In this narrative review, we sought to present the neurological manifestations associated with coronavirus disease 2019 (COVID-19). Case reports, case series, editorials, reviews, case-control and cohort studies were evaluated, and relevant information was abstracted. Various reports of neurological manifestations of previous coronavirus epidemics provide a roadmap regarding potential neurological complications of COVID-19, due to many shared characteristics between these viruses and SARS-CoV-2. Studies from the current pandemic are accumulating and report COVID-19 patients presenting with dizziness, headache, myalgias, hypogeusia and hyposmia, but also with more serious manifestations including polyneuropathy, myositis, cerebrovascular diseases, encephalitis and encephalopathy. However, discrimination between causal relationship and incidental comorbidity is often difficult. Severe COVID-19 shares common risk factors with cerebrovascular diseases, and it is currently unclear whether the infection per se represents an independent stroke risk factor. Regardless of any direct or indirect neurological manifestations, the COVID-19 pandemic has a huge impact on the management of neurological patients, whether infected or not. In particular, the majority of stroke services worldwide have been negatively influenced in terms of care delivery and fear to access healthcare services. The effect on healthcare quality in the field of other neurological diseases is additionally evaluated.

The Neurological Complexities and Prognosis of COVID-19

“…Despite unfavorable results on the nasopharyngeal swab, the CSF RT-PCR test was positive for COVID-19 [7]. Impressions of brain imaging demonstrated characteristics of encephalitis of the hippocampal region and the right mesial lobe [7,26]. CSF screening for herpes simplex virus and varicella-zoster antibodies were not detected [26].…”

“…The patient also presented with nuchal rigidity. Despite unfavorable results on the nasopharyngeal swab, the CSF RT-PCR test was positive for COVID-19 [7]. Impressions of brain imaging demonstrated characteristics of encephalitis of the hippocampal region and the right mesial lobe [7,26].…”

“…Literature analysis on COVID-19 and its neurological manifestations have been reported and analyzed as to their associated presentations in the central nervous system (CNS), peripheral nervous system (PNS, and musculoskeletal system [1,4]. Throughout a COVID-19 infection, the body is in a state of hypoxia, inflammation, and hypercoagulability; these are the possible mechanisms of neurological and cerebrovascular events [6][7][8]. Critical COVID-19 patients can also exhibit indirect neurological symptoms due to severe pulmonary complications needing ICU management [7].…”

“…Throughout a COVID-19 infection, the body is in a state of hypoxia, inflammation, and hypercoagulability; these are the possible mechanisms of neurological and cerebrovascular events [6][7][8]. Critical COVID-19 patients can also exhibit indirect neurological symptoms due to severe pulmonary complications needing ICU management [7].…”

Designing a Network Proximity-Based Drug Repurposing Strategy for COVID-19

“…The phenotype query for group 4 was: “fever” OR “cough” OR “diarrhea” OR “pain” OR “nausea” OR “vomiting” OR “chills” OR “inflammation” OR “hemorrhagic” ( Supplementary Table S8 ). For group 5 (brain tissues) 2 sets of disease-related phenotypes were used in separate VarElect analyses, accounting for the reported neurological symptoms related to the central nervous system (group 5a, phenotype query: “dizziness” OR “headache” OR “consciousness” OR “encephalopathy” OR “encephalitis” OR “seizures” OR “stroke” OR “delirium,” Supplementary Table S9 ) or the peripheral nervous system (group 5b, phenotype query: “ageusia” OR “dysgeusia” OR “hypogeusia” OR “anosmia” OR “hyposmia” OR “myalgia” OR “myelitis” OR “pain” OR “Guillain-Barre,” Supplementary Table S10 ) ( Ahmad and Rathore, 2020 ; Lahiri and Ardila, 2020 ; Tsivgoulis et al, 2020 ).…”