Prolonged Neuropsychological Deficits, Central Nervous System Involvement, and Brain Stem Affection After COVID-19—A Case Series

Abstract

Objective: The affection of both the peripheral (PNS) and central nervous system (CNS) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been assumed to play a direct role in the respiratory failure of patients with Corona virus disease 2019 (COVID-19) through affection of medullary cardiorespiratory centers resulting in neurological complications and sequelae. Methods: We used a multimodal electrophysiological approach combined with neuropsychological investigations to study functional alteration of both the PNS and CNS in four patients with severe COVID-19. Results: We found electrophysiological evidence for affection of both the PNS and CNS, and particularly affection of brain stem function. Furthermore, our neuropsychological investigations provide evidence of marked impairment of cognition independent of delirium, and outlasting the duration of acute infection with SARS-CoV-2. Conclusion: This case series provides first direct electrophysiological evidence for functional brain stem involvement in COVID-19 patients without evident morphological changes supporting the notion of the brain stem contributing to respiratory failure and thus promoting severe courses of the disease. Moreover, sustained neuropsychological sequelae in these patients may be of particular psychosocial and possibly also economic relevance for society.

Cognitive Dysfunction, Psychiatric Distress, and Functional Decline After COVID-19

“…To date, most studies have relied on brief cognitive screening measures or small case series rather than detailed neuropsychological test batteries in samples of sufficient size to permit detection of patterns of impairment and associated disease and treatment characteristics( (13) , (14) , (15) , (16) , (17) ). Much remains to be learned about the nature and severity of cognitive and psychiatric functioning across patients of varying disease severity and at various time points over the course recovery from COVID-19( 18 ).…”

A comprehensive review of COVID-19 biology, diagnostics, therapeutics, and disease impacting the central nervous system

“…Neurological symptoms from COVID-19 have been detected weeks past the acute phase (Groiss et al 2020 ). Through the use of electrophysiological studies (e.g., electroencephalography), Groiss et al found that both the peripheral nervous system and the central nervous system were affected by SARS-CoV-2 in 4 male patients.…”

“…Through the use of electrophysiological studies (e.g., electroencephalography), Groiss et al found that both the peripheral nervous system and the central nervous system were affected by SARS-CoV-2 in 4 male patients. Delirium was seen in these patients and cognition was impaired even after delirium passed (Groiss et al 2020 ). Another study showed 4 children with COVID-19 who displayed similar neurological symptoms (e.g., encephalopathy, headache, brainstems with signs of dysarthria/dysphagia, meningism, cerebellar ataxia, muscle weakness, reduced reflexes, and lesions in the splenium of corpus callosum) had little to no respiratory symptoms (Abdel-Mannan et al 2020 ).…”

Infection of Human Cells by SARS-CoV-2 and Molecular Overview of Gastrointestinal, Neurological, and Hepatic Problems in COVID-19 Patients

“…More recently, a relation between intestinal inflammation (by fecal calprotectin determination) and the incidence of fecal SARS-CoV-2 RNA in hospitalized individuals has been reported [ 82 ]. Pro-inflammatory intermediates in the GI tract can form a path to the brain through the vascular or lymphatic system [ 83 , 84 , 85 ]. Additionally, virus-welded gut inflammation may trigger cognitive functions via the vagal nerve ( Figure 4 ).…”