It becomes apparent that the neurological complications of COVID-19 are significantly common, but in some cases, establishing a causal relationship is difficult. For example, a stroke can occur for reasons unrelated to coronavirus infection, while Guillain–Barré syndrome and meningoencephalitis are likely to be a parainfection. Only long-term epidemiological studies in large groups of patients can clarify some of these issues. This will help to better understand the mechanisms of development of complications and develop schemes for their treatment and subsequent rehabilitation. The article presents the mechanisms of penetration of the coronavirus into the nervous system and systematizes the neurological manifestations and complications of COVID-19, which were described in the first 3 months of the pandemic. Particular attention is paid to the consideration of the complications of COVID-19 from the central and peripheral nervous system, the most interesting clinical examples are considered. Summing up the analysis of the literature, we can say that the clinical picture of neurological diseases and syndromes caused by coronavirus infection corresponds to the usual notions. Also considered is the assumption that SARS-CoV-2 can persist for a long time in the central nervous system in the form of inactive fragments, which means that it can recur in predisposed individuals when appropriate conditions arise. This suggestion is alarming regarding distant neurological complications in infected and cured patients.

The article discusses the management of patients with various neurological diseases during the COVID-19 pandemic, taking into account the determination of the level of risk of infection. The possibility of increasing the risk of infection in patients with disability, especially with impaired function of the respiratory and bulbar muscles, limited mobility, and the presence of concomitant diseases, is indicated. The recommendations on the treatment of patients with stroke, neuromuscular diseases, inflammatory and autoimmune diseases of the central nervous system, in particular, multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD), as well as non-inflammatory diseases of the central nervous system (epilepsy, Parkinson’s disease, atypical parkinsonism, dystonia, hereditary spastic paraplegia, infantile cerebral palsy, benign intracranial hypertension) are considered. Interactions of drugs for the treatment of COVID-19 and neurological diseases are given. Potential neurological complications of COVID-19 are overviewed. Potential neurological complications of COVID-19 were noted: anosmia, ageusia, viral meningitis, encephalitis, post-infectious stem encephalitis, acute necrotizing hemorrhagic leukoencephalopathy, Guillain-Barre syndrome, myositis. The importance of the fact that during the COVID-19 pandemic, when examining patients with neurological diseases, clinicians should take into account the possibility of a patient with COVID-19, and also consider it as a differential diagnosis in order to avoid diagnostic errors, prescribe timely treatment and prevent the spread of infection.

Резюме Актуальность. Для определения оптимального подхода к ведению пациентов в остром периоде инсульта продолжается поиск биомаркеров, которые смогут повысить ценность уже существующих методов диагностики. Цель исследования: уточнить значение уровней нейрон-специфической енолазы (НСЕ), глиального фибриллярного кислого белка (ГФКБ), NR2-антител в сыворотке крови (СК) у пациентов в остром периоде ишемического инсульта (ИИ) в динамике, определить их взаимосвязь с тяжестью неврологических нарушений и краткосрочным исходом. Материалы и методы. Обследовано 40 пациентов в остром периоде ИИ, средний возраст 72,6 ± 1,9 лет. Уровни биомаркеров определяли в СК в первые 72 часа ИИ и на 10-14 день. Результаты. Концентрация НСЕ и ГФКБ у больных с ИИ в первые 72 часа превышала референсные значения и значимо уменьшалась к 10-14 дню (34,9 ± 5,9 → 17,7 ± 1,1; p = 0,007 и 0,4 ± 0,1 → 0,2 ± 0,005; р = 0,22 соответственно). Уровень NR2-антител референсных значений не превысил (1,01 ± 0,3), а в динамике к 10-14 дню было отмечено нарастание показателя (1,1 ± 0,3), p = 0,007. У пациентов, имевших более тяжелую симптоматику, концентрация НСЕ, ГФКБ и NR2-антител к 10-14 дню была выше. Пациенты, имевшие неблагоприятный краткосрочный исход, к 10-14 дню имели более высокий уровень НСЕ, ГФКБ и NR2-антител. Заключение. Исследованные вещества могут быть использованы в качестве биомаркеров при ИИ для контроля степени повреждения мозговой ткани, мониторинга усугубления патологического процесса, а также с прогностической целью. Ключевые слова: биомаркеры инсульта, глиальный фибриллярный кислый белок, инсульт, ишемический инсульт, краткосрочный исход, нейрон-специфическая енолаза, прогноз NR2-антитела, N-метил-D-аспартат рецепторы.