COVID-19: A Perspective from Clinical Neurology and Neuroscience

Abstract

Despite the increasing large population of COVID-19+ infected patients, knowledge of the disease remains limited. Understanding the effects and long-term implications of COVID-19 will be paramount to implementing the right public health measures and developing future preventive and effective treatments. In this article, we discuss currently available information with COVID-19-related neurological complications, possible routes of virus infection into the central nervous system, and hypothesis about virus-induced cytokine storm syndrome, long-term outcomes, as well as ongoing clinical studies of novel therapies and biomarkers for COVID-19. Understanding the effects of COVID-19 on neurological systems is crucial for properly diagnosing and caring for the disease. We need to be prepared that COVID-19 could cause long-lasting debilitations after the infection has cleared. Investigating long-term effects of the disease will yield insight for providing comprehensive care to the survivors. Understanding these risks will also lead to better treatments as well as inform policies to create a system capable of caring for those affected by COVID-19 long after the pandemic has subsided.

Neuropathobiology of COVID-19: The Role for Glia

“…The clinical presentation of Spanish flu included neurological and neuropsychiatric symptoms, both acute and delayed; the H1N1 virus was arguably linked to the still mysterious encephalitis lethargica, which alone claimed 500,000 death in 1920s (Crookshank, 1919;Ravenholt and Foege, 1982). Similarly, the clinical presentation of COVID-19 frequently includes neurological symptoms and neuropathologies such as acute ischemic stroke, meningitis/encephalitis, acute necrotising haemorrhagic encephalopathy, acute Guillain-Barré syndrome (Beyrouti et al, 2020;Dixon et al, 2020;Oxley et al, 2020;Paterson et al, 2020;Pero et al, 2020;Poyiadji et al, 2020;Zhao et al, 2020) as well as psychiatric manifestations such as depression, delirium, and psychosis (Steardo et al, 2020b). The retrospective analysis revealed that up to 20-30% of patients with severe forms of COVID-19 presented signs of disrupted consciousness and altered mental status Varatharaj et al, 2020).…”

Refining “Long-COVID” by a Prospective Multimodal Evaluation of Patients with Long-Term Symptoms Attributed to SARS-CoV-2 Infection

“…Manifestations of post-acute COVID-19 syndrome are clinically diverse, and multiple underlying mechanisms are likely to be implicated. Patients who underwent extensive hospitalization due to severe disease may exhibit chronic lung or heart injury due to the heightened immune response [5,6], micro-or macrovascular thrombotic neurologic complications [7] and/or physical deconditioning [8]. Indeed, a recent cohort study found that among 1733 hospitalized COVID-19 patients, 76% reported persistence of at least one symptom after 6 months, and objective pulmonary abnormalities were found in [ 20% [9].…”

“…At a median time of 152 days after symptom onset, fever, cough and dyspnea were less frequently reported compared with the initial presentation, but paresthesia and burning pain emerged in 18 (60%) and 13 (43%) patients, respectively. The clinical examination was unremarkable in all patients, although the median fatigue and pain visual analog scales were 7 [5][6][7][8] and 5 [2][3][4][5][6], respectively. Extensive biologic studies were unremarkable, and multiplex cytokines and ultra-sensitive interferon-a2 measurements were similar between long-haulers and convalescent COVID-19 individuals without persistent symptoms.…”

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

“…The burden of disease is far higher than deaths alone, as COVID-19 is increasingly understood to cause a number of chronic ailments and disabilities (eg, cardio vascular, neurological, pulmonary, and psychiatric illnesses). 12,13 In addition, the pandemic has unleashed a secondary crisis by disrupting the supply and demand for health services. Experts project an additional 1•4 million tuberculosis deaths during 2020-25, 14 up to 673 000 HIV deaths in Africa in 2020, 15 the possibility of an additional 1•2 million deaths of children younger than 5 years, 16 an additional 56 700 maternal deaths in a 6-month period, 16 and 80 million children at risk of vaccine preventable diseases because of disruptions caused by the pandemic.…”