Isolated Chronic Aseptic Meningitis Due to SARS-COV-2 Unresponsive to Ordinary Treatments

: Serious, and sometimes, deadly complications of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are devastating. Whereas most manifestations of COVID-19 are respiratory (fever, dry cough, fatigue, pneumonia), it is getting to be progressively recognized that numerous organ functions can be affected by this disease, and the nervous system is one of them as neurological complications can affect up to 36% of adult patients. However, the prevalence and pathophysiology of these complications have yet to be fully elucidated in children. Here, we discuss an infant with neurological symptoms manifested as chronic isolated aseptic meningitis associated with COVID-19, which was unresponsive to ordinary treatments and dramatically responsive to dexamethasone. Immune-mediated reactions may have had a major pathophysiologic role in this case.

Download Full-text

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.

Download Full-text

Neurological symptoms of COVID-19

Pharmacotherapy in Psychiatry and Neurology ◽

10.33450/fpn.2020.11.001 ◽

2021 ◽

Vol 36 (4) ◽

pp. 285-296

Author(s):

Adriana Wawer ◽

Agnieszka Piechal

Keyword(s):

Nervous System ◽

Viral Infections ◽

Harmful Effect ◽

Neurological Complications ◽

Neurological Symptoms ◽

Acute Respiratory Disease ◽

Neurological Damage ◽

Impaired Consciousness ◽

Potential Impact ◽

The Brain

Objective. Some viral infections can have a harmful effect on the functioning of the nervous system and can even cause serious neurological damage. This work aims to review the results of studies published so far concerning neurological complications in people infected with coronaviruses, especially SARS-CoV-2, and possible mechanisms responsible for nervous system damage. Literature review. Recently, there have been reports that coronaviruses, including SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), cause acute respiratory disease, exhibit neurotropic properties and can also cause neurological symptoms. There are studies published showing that these viruses may penetrate to the brain and cerebrospinal fluid. Conclusions. Coronaviruses are still poorly understood, so it seems important to study the potential impact of SARS-CoV-2 infections on the nervous system. It seems appropriate that patients infected with SARS-CoV-2 should be early evaluated for neurological symptoms, including headache and impaired consciousness.

Download Full-text

Neurological manifestations associated with SARS-CoV-2 infection: a narrative review

10.5327/1516-3180.442 ◽

2021 ◽

Author(s):

Poliana Rafaela dos Santos Araújo ◽

Kauan Alves Sousa Madruga ◽

Bruna Alves Rocha ◽

Lucas Oliveira Braga

Keyword(s):

Nervous System ◽

Meta Analysis ◽

Neurological Complications ◽

Neurological Symptoms ◽

Narrative Review ◽

Common Symptom ◽

Neurological Manifestations ◽

Cns Involvement ◽

Pubmed Database ◽

Critical Patients

Background: Coronavirus disease (COVID-19), once identified, soon spread globally, becoming a pandemic. Although patients present mainly with respiratory complaints, several neurological symptoms have been reported. Symptoms range from headache and nonspecific dizziness to seizures and cerebrovascular disease (CVD). It has also been shown that the severity of the infection is directly proportional to the development of neurological symptoms, especially CVD and changes in mental status. Objective: The present study aims to briefly review the neurological manifestations of COVID-19 and discuss the pathogenic mechanisms of Central Nervous System (CNS) involvement. Methods: This is an exploratory narrative review with a descriptive approach, consisting of an active search for scientific articles in the PubMed database. The descriptors “coronavirus infections”, “COVID-19” and “Nervous system” were used, with the Boolean operators “OR” and “AND”. Eighteen articles of systematic review and meta-analysis were included. Results: CNS manifestations included, among others: encephalitis, encephalopathy, consciousness decrease, headache, dizziness, acute myelitis, and stroke. As for the peripheral nervous system, skeletal muscle damage, chemosensory dysfunction, and Guillain-Barré syndrome were observed, with hyposmia being the most common symptom. CNS involvement may be related to a worse prognosis. Conclusion: The clinical involvement of the nervous system in COVID-19 is not uncommon, and can result in several neurological complications, especially in the most critical patients. The pathophysiological mechanisms of these events still need further investigation. In the meantime, physicians should value extra-respiratory symptoms ranging from hyposmia, to potentially fatal manifestations, such as stroke and encephalopathy.

Download Full-text

The incidence and pathophysiology of neurological symptoms in COVID-19

Russian Military Medical Academy Reports ◽

10.17816/rmmar83617 ◽

2021 ◽

Vol 40 (4) ◽

pp. 33-42

Author(s):

Igor V. Litvinenko ◽

Miroslav M. Odinak ◽

Nikolay V. Tsygan ◽

Aleksander V. Ryabtsev

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Rare Complication ◽

Cranial Nerves ◽

Neurological Symptoms ◽

Immune Mediated ◽

High Incidence ◽

The Central Nervous System ◽

Coronavirus Infection

The central nervous system seems to be quite vulnerable to SARS-CoV-2, leading to a variety of alteration pathways, high incidence and variability of the neurological symptoms of COVID-19. The COVID-19 symptoms, possibly associated with alteration to the central nervous system, include hyperthermia, shortness of breath, fatigue, headache, dizziness, dysphonia, dysphagia, hyposmia and anosmia, hypogeusia and ageusia, impairment of consciousness. The impairment of olfaction and gustation are the most common symptoms of the nervous system alteration (98% and 70%, respectively), which is most likely a consequence of the alteration of the receptors. Presumably the pathogenesis of dysphonia and dysphagia may involve neurodegenerative mechanisms or may be associated with a predominantly demyelinating alteration of the caudal cranial nerves. Pathomorphological findings in the brain of the COVID-19 patients include diffuse hypoxic and focal ischemic injuries of various sizes up to ischemic infarctions (in thrombosis of large arteries); microangiopathy; vasculitis; diapedetic and confluent hemorrhages with possible progression to hemorrhagic infarctions and rarely intracerebral hematomas. Acute cerebrovascular accident worsens the course of COVID-19 and can worsen the clinical outcome, taking into account the mechanisms of the central nervous system alteration in highly contagious coronavirus infections (SARS-CoV, MERS, SARS-CoV-2), including embolism, hypoxia, neurodegeneration, systemic inflammatory response and immune-mediated alteartion to the nervous tissue. A fairly rare complication of coronavirus infection, however, acute myelitis requires attention due to the severity of neurological disorders. The literature data show high incidence and polymorphism of the symptoms of the central nervous system alteration, as well as the important role of the cerebrovascular and neurodegenerative pathogenesis of brain alteration in COVID-19, which is taken into account in examining and treating the patients with new coronavirus infection. (1 figure, bibliography: 61 refs)

Download Full-text

Non-metastatic neurological manifestations of malignancy

10.1093/med/9780199568741.003.0238 ◽

2018 ◽

Author(s):

Nerissa Jordan

Keyword(s):

Nervous System ◽

Side Effects ◽

Antibody Formation ◽

Neurological Complications ◽

Cns Infection ◽

Neurological Manifestations ◽

Local Effects ◽

Immune Mediated ◽

Neuronal Proteins ◽

Systemic Malignancy

Neurological complications of systemic malignancy are frequent. They may reflect direct local effects of the tumour; CNS infection; side effects of chemotherapy or radiotherapy; nutritional or metabolic derangements; or a paraneoplastic syndrome. The paraneoplastic neurological syndromes are a group of disorders associated with a malignancy outside the nervous system. The pathophysiology is immune-mediated, with the tumour’s expression of neuronal proteins invoking antibody formation, which in turn results in neurological symptoms. This chapter will mainly focus on these syndromes.

Download Full-text

COVID-19 Infection and Neurological Complications: Present Findings and Future Predictions

Neuroepidemiology ◽

10.1159/000508991 ◽

2020 ◽

Vol 54 (5) ◽

pp. 364-369 ◽

Cited By ~ 5

Author(s):

Ettore Beghi ◽

Valery Feigin ◽

Valeria Caso ◽

Paola Santalucia ◽

Giancarlo Logroscino

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Viral Infections ◽

Neurological Diseases ◽

Neurological Complications ◽

Influenza Viruses ◽

Surveillance Systems ◽

Care Needs ◽

The Past ◽

Immune Mediated

The present outbreak caused by SARS-CoV-2, an influenza virus with neurotropic potential, presents with neurological manifestations in a large proportion of the affected individuals. Disorders of the central and peripheral nervous system are all present, while stroke, ataxia, seizures, and depressed level of consciousness are more common in severely affected patients. People with these severe complications are most likely elderly with medical comorbidities, especially hypertension and other vascular risk factors. However, postinfectious complications are also expected. Neurological disorders as sequelae of influenza viruses have been repeatedly documented in the past and include symptoms, signs, and diseases occurring during the acute phase and, not rarely, during follow-up. Postinfectious neurological complications are the result of the activation of immune mechanisms and can explain the insurgence of immune-mediated diseases, including the Guillain-Barré syndrome and other diseases of the central and peripheral nervous system that in the past occurred as complications of viral infections and occasionally with vaccines. For these reasons, the present outbreak calls for the introduction of surveillance systems to monitor changes in the frequency of several immune-mediated neurological diseases. These changes will determine a reorganization of the measures apt to describe the interaction between the virus, the environment, and the host in areas of different dimensions, from local communities to regions with several millions of inhabitants. The public health system, mainly primary care, needs to be strengthened to ensure that research and development efforts are directed toward right needs and directions. To cope with the present pandemic, better collaboration is required between international organizations along with more research funding, and tools in order to detect, treat, and prevent future epidemics.

Download Full-text

Severe Acute Respiratory Syndrome Coronavirus 2-Induced Neurological Complications

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2020.605972 ◽

2020 ◽

Vol 8 ◽

Author(s):

Shijia Yu ◽

Mingjun Yu

Keyword(s):

Multiple Sclerosis ◽

Nervous System ◽

Severe Acute Respiratory Syndrome ◽

Respiratory Symptoms ◽

Neurological Complications ◽

Supportive Treatment ◽

Cytokine Storm ◽

Neurological Signs ◽

Underlying Mechanisms ◽

Immunomodulatory Therapies

Our review aims to highlight the neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the available treatments according to the existing literature, discussing the underlying mechanisms. Since the end of 2019, SARS-CoV-2 has induced a worldwide pandemic that has threatened numerous lives. Fever, dry cough, and respiratory symptoms are typical manifestations of COVID-19. Recently, several neurological complications of the central and peripheral nervous systems following SARS-CoV-2 infection have gained clinicians' attention. Encephalopathy, stroke, encephalitis/meningitis, Guillain–Barré syndrome, and multiple sclerosis are considered probable neurological signs of COVID-19. The virus may invade the nervous system directly or induce a massive immune inflammatory response via a “cytokine storm.” Specific antiviral drugs are still under study. To date, immunomodulatory therapies and supportive treatment are the predominant strategies. In order to improve the management of COVID-19 patients, it is crucial to monitor the onset of new neurological complications and to explore drugs/vaccines targeted against SARS-CoV-2 infection.

Download Full-text

Potential neurological manifestations of COVID-19

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000897 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000000897 ◽

Cited By ~ 1

Author(s):

Anna S. Nordvig ◽

Kathryn T. Rimmer ◽

Joshua Z. Willey ◽

Kiran T. Thakur ◽

Amelia K. Boehme ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Neurological Complications ◽

Neurological Symptoms ◽

The Novel ◽

Altered Consciousness ◽

Human Coronavirus ◽

Neurological Morbidity ◽

Neurological Patients ◽

Neurological Effects

AbstractPurposeof review: Neurological complications are increasingly recognized in the Coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is caused by the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This coronavirus is related to Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and other human coronavirus-related illnesses that are associated with neurological symptoms. These symptoms raise the question of a neuroinvasive potential of SARS-CoV-2.Recent findings:Potential neurological symptoms and syndromes of SARS-CoV-2 include headache, fatigue, dizziness, anosmia, ageusia, anorexia, myalgias, meningoencephalitis, hemorrhage, altered consciousness, Guillain-Barré Syndrome, syncope, seizure, and stroke. Additionally, we discuss neurological effects of other coronaviruses, special considerations for management of neurological patients, and possible long-term neurological and public health sequelae.Summary:As SARS-CoV-2 is projected to infect a large part of the world’s population, understanding the potential neurological implications of COVID-19 will help neurologists and others recognize and intervene in neurological morbidity during and after the pandemic of 2020.

Download Full-text

Neuroinvasion and neurological complications in COVID-19

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.2-186-187 ◽

2020 ◽

pp. 186-187

Author(s):

O.A. Loskutov

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cerebrovascular Disease ◽

Neurological Complications ◽

Neurological Symptoms ◽

Nausea And Vomiting ◽

Musculoskeletal Symptoms ◽

Control Group ◽

Consciousness Disorders ◽

The Central Nervous System

Background. Coronavirus disease (COVID-19) affects not only the alveoli but also the central nervous system. The pathogenesis of neurological complications of COVID-19 is based on the receptor damage, cytokine-mediated injury, damage of the nervous system due to hypoxia, and neuronal damage due to the retrograde transport of the virus through nerve fibers. Objective. To determine the mechanisms of coronavirus neuroinvasion and treatment of neurological complications COVID-19. Materials and methods. Analysis of literature sources and own research on this topic. Results and discussion. In 3 days after infection viral antigens are detected in the olfactory sensory neurons of the nasal cavity epithelium, which confirms the transnasal invasion of coronaviruses. According to various authors, 36.4-84 % of patients with COVID-19 have neurological manifestations. In general, neurological symptoms of COVID-19 can be divided into three categories: symptoms of the central nervous system disorders (headache, dizziness, consciousness disorders, nausea and vomiting, ataxia, acute cerebrovascular disease, and epilepsy), symptoms of the peripheral nervous system disorders (hypogeusia, hyposmia, hypopsia, and neuralgia) and musculoskeletal symptoms. As viral infections cause cytokine storm, inflammation and hyperactive oxidation, it is advisable to use antioxidants in their treatment. According to the Japanese clinical guidelines for the treatment of acute respiratory distress syndrome, edaravone may be used as a free radical scavenger in such patients. In the experiment, edaravone reduced the area of infarction and promoted functional recovery in cerebral thrombosis. Other properties of edaravone include the prevention of excessive permeability of the pulmonary vessels’ endothelium. Own research has shown that edaravone (Ksavron, “Yuria-Pharm”) reduces the severity of inflammation and mortality in patients with COVID-19. In the control group, the level of the proinflammatory mediator interleukin-6 exceeded the upper limit of normal values by 1652.40 %, and in the Ksavron group – only by 269.97 %. Mortality in the control group was 14.3 %, and in the Ksavron group – 0 %. Conclusions. 1. Coronaviruses affect not only the lungs but also the nervous system. 2. Neurological symptoms of COVID-19 include headache, dizziness, consciousness disorders, nausea and vomiting, ataxia, acute cerebrovascular disease, hypogeusia, hyposmia, hypopsia, neuralgia, and musculoskeletal symptoms. 3. Edaravone (Ksavron) reduces the severity of inflammation and has an antioxidant effect, which justifies its use in COVID-19.

Download Full-text

Neurological Manifestations of Covid-19 Hospitalized Patients In the state of Punjab, India

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v20i5.55414 ◽

2021 ◽

pp. 155-161

Author(s):

Zahoor Ahmad Parry ◽

Swapnil Sunil Bumb ◽

Santosh Kumar ◽

Rohan Bhatt ◽

Mohammed Irfan ◽

...

Keyword(s):

Nervous System ◽

Medical Science ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Neurological Complications ◽

Neurological Illness ◽

Immune Mediated ◽

The Central Nervous System ◽

Neurological Presentation ◽

The Mean

Introduction: COVID 19 often presents with flu-like symptoms. Elderly patients with systemic comorbidities are more likely to have severe COVID 19 infections and deaths. Severe neurological complications are frequently reported in severely and critically ill patients. In COVID-19, both central and peripheral nervous systems can be affected. The study aims to overview the spectrum, characteristics, and outcomes of neurologic manifestations associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: A total of 1000 confirmed CoVID-19 patients were enrolled for the study. Demographic features and initial clinical manifestations were noted, and patients were followed during the hospital stay to develop any new neurological signs and symptoms. For analytical purposes, neurological presentations were grouped into the central nervous system, peripheral nervous system, and musculoskeletal system manifestations. Appropriate laboratory testing was employed as required on a case-to-case basis. Results: The mean age was 44.6 ± 14.3 years. 625 (62.5%) patients were male, while 375 (37.5%) were female. The neurological illness was a primary manifestation in 119 (11.9%) cases. These included encephalopathy (n=78), ischemic stroke (n=28), Guillain- Barre syndrome, (n=3), facial nerve palsy (n=4), and encephalitis (n=6). The most common neurological symptoms were headache 313 (31.3%) and hyposmia 52 (5.2%), followed by encephalopathy 78 (7.8%). More serious complications like seizures 18 (1.8%) and stroke 28 (2.8%) were also seen. Conclusion: CoVID-19 can present with a neurological illness, and we should remain vigilant to the possibility of neurological presentation of COVID-19 that can be thrombo-embolic, inflammatory, or immune-mediated. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.155-161

Download Full-text