Neurological complications of critically ill COVID-19 patients

Abstract

Purpose of review COVID-19 and systemic critical illness are both associated with neurological complications. We provide an update on the diagnosis and critical care management of adult patients with neurological complications of COVID-19. Recent findingsLarge prospective multicentre studies conducted in the adult population over the last 18 months improved current knowledge on severe neurological complications of COVID-19. In COVID-19 patients presenting with neurological symptoms, a multimodal diagnostic workup (including CSF analysis, brain MRI, and EEG) may identify different syndromes associated with distinct trajectories and outcomes. Acute encephalopathy, which represents the most common neurological presentation of COVID-19, is associated with hypoxemia, toxic/metabolic derangements, and systemic inflammation. Other less frequent complications include cerebrovascular events, acute inflammatory syndromes, and seizures, which may be linked to more complex pathophysiological processes. Neuroimaging findings include infarction, haemorrhagic stroke, encephalitis, microhaemorrhages and leukoencephalopathy. In the absence of structural brain injury, prolonged unconsciousness is usually fully reversible, warranting a cautious approach for prognostication. Advanced quantitative MRI may provide useful insights into the extent and pathophysiology of the consequences of COVID-19 infection including atrophy and functional imaging changes in the chronic phase. SummaryOur review highlights the importance of a multimodal approach for the accurate diagnosis and management of complications of COVID-19, both at the acute phase and in the long-term.

SARS-CoV-2 Spike Protein Intensifies Cerebrovascular Complications in Diabetic hACE2 Mice through RAAS and TLR Signaling Activation

“…SARS-CoV-2 has been shown to cause severe inflammation in various organs, such as the lungs and kidneys, of diabetic patients [8,11]. Increased inflammation and oxidative stress in the cerebral microenvironment is one of the most acceptable theories for COVID-19induced cerebrovascular complications [17,[34][35][36].…”

SARS-CoV-2 infection exacerbates the cellular pathology of Parkinson’s disease in human dopaminergic neurons and a mouse model

“… 1 As the number of severe cases declines, it becomes imperative to anticipate and mitigate potential long-term consequences in individuals who have recovered from SARS-CoV-2 infection. Notably, a range of manifestations have been documented as sequelae thus far, including encephalitis, 2 , 3 , 4 , 5 memory loss, 6 headache (dizziness, nausea), 7 anosmia, and ageusia. 8 …”

“…Of particular interest, patients infected with SARS-CoV-2 have exhibited neurological symptoms such as headache, paresthesia, anosmia, dyslexia, ataxia, and alterations in mental status. 2 , 3 , 4 , 5 , 6 , 7 , 8 Additionally, the early stages of SARS-CoV-2 infection have been associated with transient structural abnormalities in the brain, 9 neuroinflammatory events, 2 , 3 , 4 , 5 and sensory loss such as anosmia. 8 Recent cases have reported the emergence of Parkinsonism in COVID-19 patients either during or shortly after SARS-CoV-2 infection, presenting symptoms such as rigidity, resting tremor in the upper extremities, and bradykinesia.…”

Unraveling the Shared Genetic Elements Among COVID-19 and Epilepsy: A Computational and Bioinformatics Analysis

“…Epilepsy is a chronic brain disorder in which groups of nerve cells, or neurons, in the brain sometimes send the wrong signals and cause seizures. Seizures, characterized by sudden, abnormal electrical activity in the brain, have been observed in some COVID-19 patients, especially in individuals with weakened immune systems (Sonneville et al,2023). The onset of seizures can arise from various triggers, such as sudden electrical impulses or disturbances in neural communication, often leading to sudden discomfort or even temporary paralysis in affected patients.…”