Neurological features of COVID-19 and their treatment: a review

Orsucci, Daniele; Ienco, Elena Caldarazzo; Nocita, Gianpaolo; Napolitano, Alessandro; Vista, Marco

doi:10.7573/dic.2020-5-1

Cited by 84 publications

(78 citation statements)

References 106 publications

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“…Further, SARS-COVID-19 may have a direct effect on the nervous system. A recent review of the literature suggested that COVID-19 is associated with many neurological manifestations, including confusion, and a possible CNS involvement in the COVID-19 pathophysiology, but further investigation is needed [ 15 ]. The mechanisms suggested for explaining the possible direct CNS involvement of the SARS-COV-2 include the invasion of the virus via disruption of the brain blood barrier, possible nerves injuries mediated by the immune system, and hypoxia [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of delirium on outcomes for older adults hospitalised with COVID-19

et al. 2020

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Introduction: Delirium is a frequent condition in hospitalized older patients and it usually has a negative prognostic value. A direct effect of SARS-COV-2 on the central nervous system (CNS) has been hypothesized. Objective: To evaluate the presence of delirium in older patients admitted for a suspected diagnosis of COVID-19 and its impact on in-hospital mortality. Setting and subjects: 91 patients, aged 70-years and older, admitted to an acute geriatric ward in Northern Italy from March 8th to April 17th, 2020. Methods: COVID-19 cases were confirmed by reverse transcriptase-polymerase chain reaction assay for SARS-Cov-2 RNA from nasal and pharyngeal swabs. Delirium was diagnosed by two geriatricians according to the DSM-V criteria. The number of chronic diseases was calculated among a pre-defined list of 60. The pre-disease Clinical Frailty Scale (CFS) was assessed at hospital admission. Results: Of the total sample, 39 patients died, 49 were discharged and 3 were transferred to ICU. Twenty-five patients (27.5%) had delirium. Seventy-two percent of patients with delirium died during hospitalization compared to 31.8% of those without delirium. In a multivariate logistic regression model adjusted for potential confounders, patients with delirium were four times more likely to die during hospital stay compared to those without delirium (OR = 3.98;95%CI = 1.05–17.28; p = 0.047). Conclusions: Delirium is common in older patients with COVID-19 and strongly associated with in-hospital mortality. Regardless of causation, either due to a direct effect of SARS-COV-2 on the CNS or to a multifactorial cause, delirium should be interpreted as an alarming prognostic indicator in older people.

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Section: Discussionmentioning

confidence: 99%

The impact of delirium on outcomes for older adults hospitalised with COVID-19

et al. 2020

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“…5 Central nervous diseases such as debilitating encephalopathies and ischaemic insults have been described as complications of initial Covid-19 pneumonia. 3,9 However, a study by Mao et al recognised peripheral nerve involvement, with hypogeusia (82 per cent) and hyposmia (86 per cent) classified as common symptoms of SARS-CoV-2 infection. 5,10 Ellul et al estimated the number of Covid-19 associated peripheral nervous system diseases to be between 2047 and 7737, based on extrapolations from previous severe acute respiratory syndrome and Middle East respiratory syndrome data.…”

Section: Discussionmentioning

confidence: 99%

A rise in facial nerve palsies during the coronavirus disease 2019 pandemic

2020

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Objective An increase in spontaneous lower motor neuron facial nerve (VIIth cranial nerve) palsies was seen during the severe acute respiratory syndrome coronavirus 2 outbreak in our emergency clinic. This led us to perform a single-centre cohort review. Methods A retrospective review was conducted of VIIth cranial nerve palsies from January to June 2020 and the findings were compared to those cases reviewed in the previous year. The severe acute respiratory syndrome coronavirus 2 incidence of the cohort was compared with that of the Liverpool population. Results Our VIIth cranial nerve palsy incidence in the 2020 period was 3.5 per cent (30 out of 852), 2.7 higher than last year's rate of 1.3 per cent (14 out of 1081), which was a statistically significant difference (p < 0.01). Two of the 17 patients in our cohort tested positive for severe acute respiratory syndrome coronavirus 2 (11.8 per cent), contrasting with Liverpool's severe acute respiratory syndrome coronavirus 2 incidence (0.5 per cent). Conclusion Severe acute respiratory syndrome coronavirus 2 may be responsible for an increased number of facial nerve palsies; it is important for clinicians to be aware that this may being an initial presentation of the disease.

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“…While present understanding is nascent, patients with lower cranial neuropathies post COVID-19 including vagal nerve involvement have been reported. [46] , [47] , [48] , [49] Presumably, the incidence of vocal fold paralysis and paresis following COVID-19 infection appears low given the prevalence of infection and the paucity of reports. However, mild vocal fold paresis in singers often leads to symptoms that might not be noticed by the general population but would be noticed by trained singers and singing teachers (such as vocal fatigue, effort, and range issues).…”

Section: Introductionmentioning

confidence: 99%