Central Nervous System Manifestations Associated with COVID-19

Abstract

Purpose of Review Coronavirus disease 2019 (COVID-19) has become a global health crisis of our time. The disease arises from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to angiotensin-converting enzyme 2 (ACE2) receptors on host cells for its internalization. COVID-19 has a wide range of respiratory symptoms from mild to severe and affects several other organs, increasing the complexity of the treatment. There is accumulating evidence to suggest that SARS-CoV-2 can target the nervous system. In this review, we provide an account of the COVID-19 central nervous system (CNS) manifestations. Recent Findings A broad spectrum of the CNS manifestations including headache, impaired consciousness, delirium, loss of smell and taste, encephalitis, seizures, strokes, myelitis, acute disseminated encephalomyelitis, neurogenic respiratory failure, encephalopathy, silent hypoxemia, generalized myoclonus, neuroleptic malignant syndrome and Kawasaki syndrome has been reported in patients with COVID-19. Summary CNS manifestations associated with COVID-19 should be considered in clinical practice. There is a need for modification of current protocols and standing orders to provide better care for COVID-19 patients presenting with neurological symptoms.

The Olfactory Organ Is Populated by Neutrophils and Macrophages During Early Development

“…A fascinating question, brought to the fore by the current SARS-CoV2 pandemic, is how viruses gain access to the nervous system, and it is now apparent that the olfactory system is used by COVID-19 (coronavirus disease 2019) as an entry point to the nervous system (Desai and Oppenheimer, 2020 ; Divani et al, 2020 ). The study of the peripheral olfactory sensory system and the associated immune cells will allow us to better understand not only the rapid immune response to damage caused by toxic and infectious agents, but also how this neural immune interface may act as a host defense niche protecting the CNS.…”

Peripheral Nervous System Manifestations Associated with COVID-19

“…The public health burden of COVID-19 has become one of the highest among infectious respiratory illnesses. There has been a widening pattern of central nervous system (CNS) involvement associated with COVID-19 [ 3 •]. Furthermore, a growing body of literature links COVID-19 to peripheral nervous system (PNS) manifestations.…”

Process Changes for Stroke Care and Electroencephalography on a Neurology Service in a Hospital at the Epicenter of the COVID-19 Pandemic

“…Public hospitals became deluged with patients as the communities they serve, urban poor and minority, were disproportionately affected by the disease. COVID-19 often affects the nervous system with both central and peripheral sequalae, neurology services had to adapt to a new landscape (2)(3)(4)(5)(6). This paper will report on the process changes for the neurology service, in particular for stroke and electroencephalography (EEG) services, at King County Hospital Center (KCHC), a 637 bed, public, university-affiliated, teaching hospital in central Brooklyn, New York, which serves a predominantly African American community.…”

“…Public hospitals became deluged with patients as the communities they serve, urban poor and minority, were disproportionately affected by the disease. COVID-19 often affects the nervous system with both central and peripheral sequalae, neurology services had to adapt to a new landscape ( 2 – 6 ).…”