Neurological manifestations due to, during and after COVID-19

With the ongoing pandemic of coronavirus disease 2019 (COVID-19), many neurological manifestations have been linked to what began as an outbreak of atypical pneumonia. Like other corona viruses, severe acute respiratory syndrome coronavirus (SARS-CoV-2) has potential for neurotropism. Viral invasion and likely pathogenecity has been associated with expression of ACE-2 receptors along endothelia and olfactory mucosa. Hyperinflammatory response after systemic infection is in part responsible for the severity and multi-organ dysfunction seen in severe cases. Features like encephalitis, central and peripheral demyelinating disorders, cranial neuropathies, stroke are seen not only in patients with severe illness but at times preceding any systemic symptoms. Neurological disorders are not only part of acute illness phase but also seen in postinfectious phase likely due to immune mediated effect. Also, long term sequelae in patients with moderate to severe COVID-19, either due to systemic complications or direct virus mediated effect are a matter of concern. High suspicion and early recognition of possible presenting features and neurological complications in severely affected patients is key for management. With the rapidity and enormity of ongoing pandemic whether these observations are causal or casual is yet to be determined. Further collaborations for comparisons of observations across the world in necessary to understand the potential impact of COVID-19. Accessing these observations will help in better understanding the agent host and environmental factors determining the expected impact of this pandemic. Reorganizing health care facilities to apt for better handling COVID-19 over time to come will help to mitigate the impact. Keywords: COVID-19; neurological manifestations; encephalitis; stroke; neurotropism

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Are We Overlooking Stroke Chameleons? A Retrospective Study on the Delayed Recognition of Stroke Patients

Cerebrovascular Diseases ◽

10.1159/000471929 ◽

2017 ◽

Vol 44 (1-2) ◽

pp. 83-87 ◽

Cited By ~ 3

Author(s):

Pitcha Chompoopong ◽

Nassir Rostambeigi ◽

Darine Kassar ◽

Alberto Maud ◽

Ihtesham A. Qureshi ◽

...

Keyword(s):

Ischemic Stroke ◽

Early Recognition ◽

Systemic Infection ◽

Neurological Manifestations ◽

Stroke Patients ◽

Organ Systems ◽

Atypical Manifestations ◽

Delayed Recognition ◽

Ischemic Attack ◽

The Impact

Background and Purpose: New effective recanalization therapies are currently available for acute ischemic stroke; yet a vast majority of stroke patients are left untreated. The lack of early recognition may be because often times, stroke patients present with atypical manifestations that resemble other conditions (which are referred to as “stroke chameleons”). We set to study the proportion of patients with delayed stroke recognition in a single center. Methods: We performed a retrospective analysis of a prospectively collected data over a 9-year period. All adult patients discharged with the diagnosis of ischemic stroke or transient ischemic attack (TIA) were identified and traced for their diagnosis on admission. Those cases with a diagnosis other than ischemic stroke or TIA on admission were identified as possible stroke chameleons and categorized into different groups according to the occurrence of neurological or non-neurological manifestations at presentation. Results: Of 2,303 cases with discharge diagnosis of ischemic stroke or TIA, 919 (39.9%) were found to be possible stroke chameleons. More than half of these patients (58.4%) presented with neurological manifestations including disorders of the somatic sensation (33%), alteration of consciousness (30%), and disorders of speech/language (11%). The remaining possible stroke chameleons had manifestations pertaining to other organ systems such as cardiopulmonary, gastrointestinal, systemic infection, trauma, and thromboembolic events elsewhere. Conclusions: In our cohort, a surprisingly large percentage of possible stroke chameleons was observed. It is important to confirm our findings, study the impact on clinical outcome, and develop strategies for early stroke patient recognition.

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SARS-CoV-2 and the Nervous System: From Clinical Features to Molecular Mechanisms

International Journal of Molecular Sciences ◽

10.3390/ijms21155475 ◽

2020 ◽

Vol 21 (15) ◽

pp. 5475 ◽

Cited By ~ 11

Author(s):

Manuela Pennisi ◽

Giuseppe Lanza ◽

Luca Falzone ◽

Francesco Fisicaro ◽

Raffaele Ferri ◽

...

Keyword(s):

Nervous System ◽

Molecular Mechanisms ◽

Neuronal Damage ◽

Neurological Complications ◽

Neurological Manifestations ◽

Wide Range ◽

Inflammatory State ◽

Acute Polyneuropathy ◽

The Central Nervous System ◽

The Impact

Increasing evidence suggests that Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) can also invade the central nervous system (CNS). However, findings available on its neurological manifestations and their pathogenic mechanisms have not yet been systematically addressed. A literature search on neurological complications reported in patients with COVID-19 until June 2020 produced a total of 23 studies. Overall, these papers report that patients may exhibit a wide range of neurological manifestations, including encephalopathy, encephalitis, seizures, cerebrovascular events, acute polyneuropathy, headache, hypogeusia, and hyposmia, as well as some non-specific symptoms. Whether these features can be an indirect and unspecific consequence of the pulmonary disease or a generalized inflammatory state on the CNS remains to be determined; also, they may rather reflect direct SARS-CoV-2-related neuronal damage. Hematogenous versus transsynaptic propagation, the role of the angiotensin II converting enzyme receptor-2, the spread across the blood-brain barrier, the impact of the hyperimmune response (the so-called “cytokine storm”), and the possibility of virus persistence within some CNS resident cells are still debated. The different levels and severity of neurotropism and neurovirulence in patients with COVID-19 might be explained by a combination of viral and host factors and by their interaction.

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Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

Journal of Neurology ◽

10.1007/s00415-021-10406-y ◽

2021 ◽

Author(s):

Biyan Nathanael Harapan ◽

Hyeon Joo Yoo

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Case Reports ◽

Case Series ◽

Altered Mental Status ◽

Neurological Complications ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Fisher Syndrome ◽

Novel Coronavirus ◽

The Impact

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and was first identified in Wuhan, China in December 2019. It is evident that the COVID-19 pandemic has become a challenging world issue. Although most COVID-19 patients primarily develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with COVID-19 have been observed. In this narrative review, we elaborate on proposed neurotropic mechanisms and various neurological symptoms, manifestations, and complications of COVID-19 reported in the present literature. For this purpose, a review of all current published literature (studies, case reports, case series, reviews, editorials, and other articles) was conducted and neurological sequelae of COVID-19 were summarized. Essential and common neurological symptoms including gustatory and olfactory dysfunctions, myalgia, headache, altered mental status, confusion, delirium, and dizziness are presented separately in sections. Moreover, neurological manifestations and complications that are of great concern such as stroke, cerebral (sinus) venous thrombosis, seizures, meningoencephalitis, Guillain–Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome (PRES) are also addressed systematically. Future studies that examine the impact of neurological symptoms and manifestations on the course of the disease are needed to further clarify and assess the link between neurological complications and the clinical outcome of patients with COVID-19. To limit long-term consequences, it is crucial that healthcare professionals can early detect possible neurological symptoms and are well versed in the increasingly common neurological manifestations and complications of COVID-19.

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SARS-CoV-2 Infection and Guillain-Barré Syndrome

Pathogens ◽

10.3390/pathogens10080936 ◽

2021 ◽

Vol 10 (8) ◽

pp. 936

Author(s):

Huda Makhluf ◽

Henry Madany

Keyword(s):

Neurological Complications ◽

Guillain Barre Syndrome ◽

Neurological Deficits ◽

Severe Illness ◽

Special Focus ◽

Neurological Manifestations ◽

Guillain Barré Syndrome ◽

Guillain Barré ◽

Global Threat ◽

Taste And Smell

Severe acute respiratory syndrome coronavirus strain 2 (SARS-CoV-2) is a beta-coronavirus that emerged as a global threat and caused a pandemic following its first outbreak in Wuhan, China, in late 2019. SARS-CoV-2 causes COVID-19, a disease ranging from relatively mild to severe illness. Older people and those with many serious underlying medical conditions such as diabetes, heart or lung conditions are at higher risk for developing severe complications from COVID-19 illness. SARS-CoV-2 infections of adults can lead to neurological complications ranging from headaches, loss of taste and smell, to Guillain–Barré syndrome, an autoimmune disease characterized by neurological deficits. Herein we attempt to describe the neurological manifestations of SARS-CoV2 infection with a special focus on Guillain-Barré syndrome.

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Treatment of Shiga-Toxin Hus with Severe Neurologic Features with Eculizumab

Case Reports in Pediatrics ◽

10.1155/2021/8053246 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Jacob H. Umscheid ◽

Collin Nevil ◽

Rhythm Vasudeva ◽

Mohammed Farhan Ali ◽

Nisha Agasthya

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Current Literature ◽

Shiga Toxin ◽

Complement Activation ◽

Early Recognition ◽

Neurological Complications ◽

Current Data ◽

Systemic Complications ◽

Uremic Syndrome

Hemolytic Uremic Syndrome (HUS) is a constellation of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Shiga toxin-producing Escherichia coli- (STEC-) mediated HUS is a common cause of acute renal failure in children and can rarely result in severe neurological complications such as encephalopathy, seizures, cerebrovascular accidents, and coma. Current literature supports use of eculizumab, a monoclonal antibody that blocks complement activation, in atypical HUS (aHUS). However, those with neurologic complications from STEC-HUS have complement activation and deposition of aggregates in microvasculature and may be treated with eculizumab. In this case report, we describe a 3-year-old boy with diarrhea-positive STEC-HUS who developed severe neurologic involvement in addition to acute renal failure requiring renal replacement therapy. He was initiated on eculizumab therapy, with clinical improvement and organ recovery. This case highlights systemic complications of STEC-HUS in a pediatric patient. The current literature is limited but has suggested a role for complement mediation in cases with severe complications. We review the importance of early recognition of complications, use of eculizumab, and current data available.

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Use of Antioxidants for the Neuro-Therapeutic Management of COVID-19

Antioxidants ◽

10.3390/antiox10060971 ◽

2021 ◽

Vol 10 (6) ◽

pp. 971

Author(s):

Noemí Cárdenas-Rodríguez ◽

Cindy Bandala ◽

América Vanoye-Carlo ◽

Iván Ignacio-Mejía ◽

Saúl Gómez-Manzo ◽

...

Keyword(s):

Neuromuscular Junctions ◽

Cardiac Injury ◽

Clinical Manifestations ◽

Specific Treatment ◽

Kidney Injury ◽

Neurological Complications ◽

Neurological Manifestations ◽

Systemic Complications ◽

The Central Nervous System ◽

Brain Tissue Damage

Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is an emergent infectious disease that has caused millions of deaths throughout the world. COVID-19 infection’s main symptoms are fever, cough, fatigue, and neurological manifestations such as headache, myalgias, anosmia, ageusia, impaired consciousness, seizures, and even neuromuscular junctions’ disorders. In addition, it is known that this disease causes a series of systemic complications such as adverse respiratory distress syndrome, cardiac injury, acute kidney injury, and liver dysfunction. Due to the neurological symptoms associated with COVID-19, damage in the central nervous system has been suggested as well as the neuroinvasive potential of SARS-CoV-2. It is known that CoV infections are associated with an inflammation process related to the imbalance of the antioxidant system; cellular changes caused by oxidative stress contribute to brain tissue damage. Although anti-COVID-19 vaccines are under development, there is no specific treatment for COVID-19 and its clinical manifestations and complications; only supportive treatments with immunomodulators, anti-vascular endothelial growth factors, modulating drugs, statins, or nutritional supplements have been used. In the present work, we analyzed the potential of antioxidants as adjuvants for the treatment of COVID-19 and specifically their possible role in preventing or decreasing the neurological manifestations and neurological complications present in the disease.

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Impact of COVID-19 on psychiatric services and presentations in north-west Edinburgh

BJPsych Open ◽

10.1192/bjo.2021.237 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S74-S75

Author(s):

Ritika Devadas ◽

Douglas Murdie ◽

Idris Thomas ◽

Rhona Hannah ◽

Wiktoria Karbowniczek ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Hospital Admissions ◽

Early Recognition ◽

Psychiatric Services ◽

Severe Illness ◽

Healthcare Provision ◽

North West ◽

The North ◽

The Impact

AimsCOVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).MethodMeasures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.ResultReferrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.ConclusionThe COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.

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Neurological aspects of COVID-19

Kazan medical journal ◽

10.17816/kmj2021-877 ◽

2021 ◽

Vol 102 (6) ◽

pp. 877-886

Author(s):

M B Aliyeva ◽

S S Saparbayev ◽

D N Ayaganov ◽

M S Kurmangazin ◽

N M Tuychibaeva

Keyword(s):

Neurological Disorders ◽

Neurological Complications ◽

Neurological Manifestations ◽

Hypoxemic Respiratory Failure ◽

Systemic Complications ◽

Central Nervous System Damage ◽

Neuropsychiatric Complications ◽

Taste Disorders ◽

Hepatic Lesions ◽

The City

The coronavirus disease COVID-19 began to spread worldwide in December 2019 from the city of Wuhan (China). COVID-19 is often accompanied by fever, hypoxemic respiratory failure and systemic complications (for example, gastrointestinal, renal, cardiac, neurological, and hepatic lesions), thrombotic phenomena. Central nervous system damage is caused by the primary effect on it, direct neuroinvasion of the virus, and more often by secondary effect due to systemic hyperinflammation. Neurological manifestations include fatigue, headache, insomnia, and olfactory/taste disorders. Neurological manifestations and complications of COVID-19 are diverse: (1) cerebral circulatory disorders, including ischemic stroke and macro/microhemorrhages; (2) encephalopathy; (3) para/postinfectious autoimmune complications, such as GuillainBarre syndrome; (4) meningoencephalitis; (5) neuropsychiatric complications (psychosis and mood disorders). In terms of pathogenesis, neurological disorders in COVID-19 can be caused by neurotropicity and neurovirulence of SARS-CoV-2, cytokine storm, hypoxemia, homeostasis disorders, as well as their combined effects. COVID-19 adversely affects the course and prognosis of chronic neurological disorders in comorbid patients. The review highlights the need for vigilance to early neurological complications in patients infected with SARS-CoV-2 and other coronaviruses, especially since some neurological complications may precede respiratory manifestations.

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Neurological Complications in COVID-19 Patients and its Implications for Associated Mortality

Current Neurovascular Research ◽

10.2174/1567202617666200727124704 ◽

2020 ◽

Vol 17 (4) ◽

pp. 522-530

Author(s):

Hanin A. AboTaleb

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Current Knowledge ◽

Rna Virus ◽

Delayed Diagnosis ◽

Neurological Complications ◽

Neurological Manifestations ◽

Positive Polarity ◽

Zoonotic Viruses ◽

The Common ◽

The Impact

: Coronavirus is an enveloped, non-segmented, positive-polarity and single-stranded RNA virus. It has four types of genera that infect mammals and birds, with only alpha and beta types found to affect humans with varying severity. A specific clade of beta coronaviruses is reported as lethal zoonotic viruses and has created major epidemic troubles, starting with the severe acute respiratory syndrome (SARS) in 2002, then the Middle East respiratory syndrome (MERS) in 2012, and lastly Coronavirus Disease 2019 (COVID-19) in 2019. However, many neurological complications reported in COVID-19 patients have highlighted a critical pattern of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Awareness of such an association could create new insight to consider neurological manifestations as a COVID-19 differential diagnosis during the pandemic period of COVID-19 to avoid delayed diagnosis and prevent further transmission. : This mini-review aims to collect the current knowledge regarding the mechanism behind the neuroinvasive capacity of SARS-CoV-2, to summarize the common documented neurological symptoms and associated complications in COVID-19 patients, and to review the impact of neurological manifestations on COVID-19 mortality.

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Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa070 ◽

2020 ◽

Cited By ~ 1

Author(s):

Prateek Kumar Panda ◽

Indar Kumar Sharawat ◽

Pragnya Panda ◽

Vivekanand Natarajan ◽

Rahul Bhakat ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Meta Analysis ◽

Random Effect ◽

Case Series ◽

Neurological Complications ◽

Severe Illness ◽

Neurological Manifestations ◽

Eligibility Criteria ◽

Symptomatic Seizures

Abstract Background Knowledge about neurological complications of COVID-19 in children is limited due to the paucity of data in the existing literature. Some systematic reviews are available describing overall clinical features of COVID-19 in children and neurological complications of COVID-19 in adults. But to the best of our knowledge, no systematic review has been performed to determine neurological manifestations of COVID-19. Methods Six different electronic databases (MEDLINE, EMBASE, Web of Science, CENTRAL, medRxiv and bioRxiv) were searched for articles related to COVID-19 and neurological complications in children. Studies/case series reporting neurological manifestations of COVID-19 in patients aged ≤18 years, as well as case reports, as neurological complications appear to be rare. The pooled estimate of various non-specific and specific neurological manifestations was performed using a random effect meta-analysis. Results Twenty-one studies/case series and five case reports (3707 patients) fulfilled the eligibility criteria and were included in this systematic review, from a total of 460 records. Headache, myalgia and fatigue were predominant non-specific neurological manifestations, presenting altogether in 16.7% cases. Total of 42 children (1%) were found to have been reported with definite neurological complications, more in those suffering from a severe illness (encephalopathy—25, seizure—12, meningeal signs—17). Rare neurological complications were intracranial hemorrhage, cranial nerve palsy, Guillain–Barré syndrome and vision problems. All children with acute symptomatic seizures survived suggesting a favorable short-term prognosis. Conclusion Neurological complications are rare in children suffering from COVID-19. Still, these children are at risk of developing seizures and encephalopathy, more in those suffering from severe illness.

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