Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians

Maury, A; Lyoubi, Aïcha; Peiffer-Smadja, Nathan; Broucker, T. de; Meppiel, Elodie

doi:10.1016/j.neurol.2020.10.001

Cited by 187 publications

(186 citation statements)

References 105 publications

(194 reference statements)

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“…The SARS-CoV-2 infection has been attributed to neurological abnormalities in a recent study, and is consistent with a variety of pathogenic pathways, including post-infectious processes, septic-associated encephalopathies, coagulopathy, and endothelitis. There is no definitive evidence that SARS-CoV-2 is neuropathogenic [ 217 ]. Despite many inconsistencies, research has demonstrated a connection between SARS-CoV-2 infection and neurological disorders, including Alzheimer’s disease [ 218 , 219 , 220 , 221 ].…”

Section: Inflammatory Cytokines and Multiple Organ Damagementioning

confidence: 99%

Diverse Immunological Factors Influencing Pathogenesis in Patients with COVID-19: A Review on Viral Dissemination, Immunotherapeutic Options to Counter Cytokine Storm and Inflammatory Responses

et al. 2021

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The pathogenesis of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still not fully unraveled. Though preventive vaccines and treatment methods are out on the market, a specific cure for the disease has not been discovered. Recent investigations and research studies primarily focus on the immunopathology of the disease. A healthy immune system responds immediately after viral entry, causing immediate viral annihilation and recovery. However, an impaired immune system causes extensive systemic damage due to an unregulated immune response characterized by the hypersecretion of chemokines and cytokines. The elevated levels of cytokine or hypercytokinemia leads to acute respiratory distress syndrome (ARDS) along with multiple organ damage. Moreover, the immune response against SARS-CoV-2 has been linked with race, gender, and age; hence, this viral infection’s outcome differs among the patients. Many therapeutic strategies focusing on immunomodulation have been tested out to assuage the cytokine storm in patients with severe COVID-19. A thorough understanding of the diverse signaling pathways triggered by the SARS-CoV-2 virus is essential before contemplating relief measures. This present review explains the interrelationships of hyperinflammatory response or cytokine storm with organ damage and the disease severity. Furthermore, we have thrown light on the diverse mechanisms and risk factors that influence pathogenesis and the molecular pathways that lead to severe SARS-CoV-2 infection and multiple organ damage. Recognition of altered pathways of a dysregulated immune system can be a loophole to identify potential target markers. Identifying biomarkers in the dysregulated pathway can aid in better clinical management for patients with severe COVID-19 disease. A special focus has also been given to potent inhibitors of proinflammatory cytokines, immunomodulatory and immunotherapeutic options to ameliorate cytokine storm and inflammatory responses in patients affected with COVID-19.

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Section: Inflammatory Cytokines and Multiple Organ Damagementioning

confidence: 99%

Diverse Immunological Factors Influencing Pathogenesis in Patients with COVID-19: A Review on Viral Dissemination, Immunotherapeutic Options to Counter Cytokine Storm and Inflammatory Responses

et al. 2021

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“…The pandemic state of COVID -19, now having lasted more than 12 months, has resulted in new clinical manifestations and neurological post-infection syndromes of SARS-CoV-2 infection, involving both central and peripheral nervous systems [1]. The most commonly occurring in the acute phase of infection include ischaemic and haemorrhagic strokes, cerebral venous thrombosis, posterior reversible encephalopathy (PRES), and those of autoimmunological origin presenting as Guillain-Barre, Miller Fisher syndromes and Bickerstaff 's encephalitis, acute demyelinating encephalomyelitis (ADEM), acute necrotising encephalopathy (ANE), generalised myoclonus, acute transverse myelitis, limbic encephalitis, and miscellaneous encephalitis [1,2]. Recently, several papers have reported ataxia-myoclonus syndrome following SARS-CoV-2 infection (Tab.…”

mentioning

confidence: 99%

Two COVID-19-related video-accompanied cases of severe ataxia-myoclonus syndrome

Przytuła¹,

Błądek²,

Sławek

2021

Neurol Neurochir Pol.

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Aim of study. The pandemic state of COVID-19 has resulted in new neurological post-infection syndromes. Recently, several papers have reported ataxia-myoclonus syndrome following SARS-CoV-2 infection. The aim of this study was to present our two cases and compare them to previously reported cases.Materials and methods. We present two video-accompanied new cases with ataxia-myoclonus syndrome following SARS--CoV-2 infection and discuss the studies published so far.Results. Ataxia-myoclonus syndrome, isolated myoclonus, opsoclonus-myoclonus syndrome as post-COVID-19 syndrome following infection have been described in 16 patients (including our two cases). Patients have been treated with intravenous immunoglobulins and/or steroids except for 4 patients, which resulted in a significant improvement within 1-8 weeks.Conclusions and clinical implications. The increasing number of patients with a similar symptomatology shows a significant relationship between COVID-19 infection and ataxia-myoclonus syndrome. The subacute onset of neurological symptoms after a resolved COVID-19 infection and prominent response to immunotherapy may suggest that the neurological manifestations are immune-mediated. Although recovery is highly possible, it may take several weeks/months, and clinicians should be aware of this diagnosis and the beneficial effects of immunological treatment administered as soon as possible.

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“…Statistics of the clinical symptoms of COVID-19 revealed that sputum production was more common in patients with moderate pneumonia, while headache appeared to be more pronounced in severe/critical patients. Some studies suggest that SARS-CoV-2 virus is not only con ned to the respiratory tract, but may also invade the central nervous system [34][35][36][37], and further studies are needed to clarify whether central nervous system infections are more pronounced in critically ill patients [38]. In addition, we similarly found that, the prevalence of comorbidities is found to be signi cantly different according to disease severity: higher in the severe/critical group.…”

Section: Discussionmentioning

confidence: 51%

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

Zeng

Jian

Zhong

et al. 2021

Preprint

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Background: COVID-19 had caused more than 2.8 million deaths globally, and the epidemic will persist for an extended period of time. We analyzed clinical features of patients in the early stage of the epidemic, so as to deepen the understanding of the disease.Methods: In this retrospective study, we included 84 confirmed cases of COVID-19 during February 1, 2020 and March 31, 2020. Baseline data were used to classify patients as moderate (57%) or severe/critical based on Chinese protocol. We focused on analyzing the differences in chest computed tomography (CT) between the two groups. Results: Of the 84 cases, 50 were male and the median age was 69 years. 55 (65%) patients had comorbidities at admission, more in the severe/critical group (P=0.040). 94% patients had bilateral lesions on CT, up to 68% had lesions involving all lobes. Ground glass opacification (GGO) (96%), consolidation (44%), Linear opacities (50%) and Air bronchogram (23%) were the mainly lesions. The lesion was gradually absorbed over time, but imaging abnormalities can persist for a long time. Compared with moderate cases, the severe/critical group had more pulmonary consolidation changes (P=0.044) and significantly higher CT severity Score (CTSS) (P=0.040). Lymphocyte counts were significantly lower (P=0.011) and NLR were higher (P=0.029) in severe/critical cases. Conclusions: Chest CT showed bilateral and multiple GGO and consolidation mainly. After treatment, pulmonary lesions were gradually absorbed over time, and imaging abnormalities can be persistent for a long time. Lung consolidation, CTSS, comorbidity, lymphocyte counts, and NLR may be predictors of severe COVID-19.

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Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians

Cited by 187 publications

References 105 publications

Diverse Immunological Factors Influencing Pathogenesis in Patients with COVID-19: A Review on Viral Dissemination, Immunotherapeutic Options to Counter Cytokine Storm and Inflammatory Responses

Diverse Immunological Factors Influencing Pathogenesis in Patients with COVID-19: A Review on Viral Dissemination, Immunotherapeutic Options to Counter Cytokine Storm and Inflammatory Responses

Two COVID-19-related video-accompanied cases of severe ataxia-myoclonus syndrome

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

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