The unfolding palette of COVID-19 multisystemic syndrome and its neurological manifestations

Abstract

Although our current knowledge of the pathophysiology of COVID-19 is still fragmentary, the information so far accrued on the tropism and life cycle of its etiological agent SARS-CoV-2, together with the emerging clinical data, suffice to indicate that the severe acute pulmonary syndrome is the main, but not the only manifestation of COVID-19. Necropsy studies are increasingly revealing underlying endothelial vasculopathies in the form of micro-haemorrhages and micro-thrombi. Intertwined with defective antiviral responses, dysregulated coagulation mechanisms, abnormal hyper-inflammatory reactions and responses, COVID-19 is disclosing a wide pathophysiological palette. An additional property in categorising the disease is the combination of tissue (e.g. neuro- and vasculo-tropism) with organ tropism, whereby the virus preferentially attacks certain organs with highly developed capillary beds, such as the lungs, gastrointestinal tract, kidney and brain. These multiple clinical presentations confirm that the acute respiratory syndrome as described initially is increasingly unfolding as a more complex nosological entity, a multiorgan syndrome of systemic breadth. The neurological manifestations of COVID-19, the focus of this review, reflect this manifold nature of the disease.

MRI negative myelopathy post mild SARS-CoV-2 infection: vasculopathy or inflammatory myelitis?

“…This may indicate a different etiology of the myelopathies in these patients. SARS-CoV-2 infection has been shown to cause both microhemorrhages and small vessel micro-thromboses through endothelial damage, coagulopathies, and antiphospholipid antibody-like syndrome (McFadyen et al 2020 ; Salamanna et al 2019 Jul 3 ; Barrantes 2021 ). Small vessel spinal cord strokes may explain the lack of apparent radiologic findings, lack of response to immunotherapeutic agents, and less recovery.…”

Non-permissive SARS-CoV-2 infection in human neurospheres

“…However, it was shown in rodents that SARS-CoV-2 infects non-neural cells in the olfactory epithelium rather than olfactory neurons, which could be attributed to the lack of expression of ACE2 in these cells ( Brann et al, 2020 , Bryche et al, 2020 ). In contrast, a recent study found viral particles throughout olfactory neuron projections and in the olfactory bulb of a few patients ( Meinhardt et al, 2020 ) and other hypotheses have been proposed ( Barrantes, 2021 ). Therefore, due to these conflicting findings, it is still debatable whether the mechanism of SARS-CoV-2 invasion in the CNS is via olfactory neurons.…”

COVID-19: neurologische Manifestationen – Update

“…Im Verlauf der Pandemie wurden neben den akuten Manifestationen einer COVID-19-Infektion Symptome untersucht, die eine länger anhaltende chronische Verlaufsform der Erkrankung mit neurologischen/neuropsychiatrischen, pulmonalen, kardialen und gastrointestinalen Beschwerden vermuteten lassen [ 4 ]; Letztere werden hier nicht weiter ausgeführt. Das Post-COVID-19-Syndrom kann sich dabei als anhaltende COVID-19-Symptomatik (z.…”