A Contemporary Review of Neurological Sequelae of COVID-19

Abstract

Coronavirus 2019 (COVID-19) is currently the center of what has become a public health crisis. While the virus is well-known for its trademark effects on respiratory function, neurological damage has been reported to affect a considerable proportion of severe cases. To characterize the neuro-invasive potential of this disease, a contemporary review of COVID-19 and its neurological sequelae was conducted using the limited, but growing, literature that is available. These neurological squeal are based on the manifestations that the virus has on normal central and peripheral nervous system function. The authors present the virology of the SARS-CoV-2 agent by analyzing its classification as an enveloped, positive-stranded RNA virus. A comprehensive timeline is then presented, indicating the progression of the disease as a public health threat. Furthermore, underlying chronic neurological conditions potentially lead to more adverse cases of COVID-19. SARS-CoV-2 may reach ACE2 receptors on neuronal tissue through mode of the general circulation. The CNS may also be susceptible to an immune response where a "cytokine storm" can manifest into neural injury. Histological evidence is provided, while symptoms such as headache and vertigo are highlighted as CNS manifestations of COVID-19. Treatment of these symptoms is addressed with paracetamol being recommended as a possible, but not conclusive, treatment to some CNS symptoms. The authors then discuss the peripheral nervous system sequelae and COVID's impact on causing chemosensory dysfunction starting with viral attack on olfactory sensory neurons and cells types within the lining of the nose. Histological evidence is also provided while symptoms such as anosmia and ageusia are characterized as PNS manifestations. Possible treatment options for these symptoms are then addressed as a major limitation, as anecdotal, and not conclusive evidence can be made. Finally, preventive measures of the neurological sequelae are addressed using a multidirectional approach. Postmortem examinations of the brains of COVID-19 patients are suggested as being a possible key to formulating new understandings of its neuropathology. Lastly, the authors suggest a more comprehensive neurological follow-up of recovered patients, in order to better characterize the neurological sequelae of this illness.

Neurological Consequences of SARS-CoV-2 Infection and Concurrence of Treatment-Induced Neuropsychiatric Adverse Events in COVID-19 Patients: Navigating the Uncharted

“…Importantly, the COVID-19 associated dysgeusia may be explained by the viral replication in the solitary tract neurons. It is also suggested that SARS-CoV-2 can disrupt the chemoreceptors by invading the olfactory mucosa to trigger an inflammatory response ( Fiani et al, 2020 ). The COVID-19 associated early anosmia may be a result of the early neuroinvasion, probably through the olfactory bulb as HCoV utilizes retrograde transport to reach the olfactory nerve.…”

Psychological outcomes after hospitalization for COVID-19: data from a multidisciplinary follow-up screening program for recovered patients

“…The infection may result in the COronaVIrus Disease 2019 (COVID-19), a severe systemic disease, in which pneumonia is the dominant clinical manifestation, but also other systems might be involved, such as cardiovascular, nephrological and neurological (Bansal, 2020 ; Bose & McCarthy, 2020 ; Fiani, Covarrubias, Desai, Sekhon, & Jarrah, 2020 ; Tadolini et al , 2020 ), leading to the need for hospitalization. Hospitalized COVID-19 patients had to deal with a complex and potentially highly stressful situation: as known from other infectious pandemics, patients have been exposed to several stressors such as isolation, uncertainty about treatment and prognosis, fear of death and of infecting loved ones, and lack of support from relatives (Chua et al , 2003).…”

Assessment of Post SARS CoV 2 Fatigue among Physicians Working in COVID Designated Hospitals in Dhaka, Bangladesh

“…COVID 19 has created an unprecedented public health emergency for almost a year since its emergence from Wuhan, China in December 2019 (Novel Coronavirus -China, 2021) . With the alarming rate of infectivity, considerable rate of mortality, and privation of effective treatment as well as an effective vaccine to prevent transmission, has made the disease the biggest health and economic threat of the century (Fiani et al, 2020). Although initially emerged as a respiratory illness, COVID-19 was later established to cause more widespread symptomatology for its affinity to ACE-2 receptors (Carod Artal, 2020).…”