Neurological manifestations in COVID-19 and its possible mechanism

Tang, Xiaojia; Luo, Yuhan; Song, Yuxia; Fan, Hongyang; Dong, Sisi; Li, Peipei; Chen, Yingzhu

doi:10.18632/aging.103732

Cited by 5 publications

(5 citation statements)

References 80 publications

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“…Rhabdomyolysis characterized by myalgia, fatigue, and hemoglobinuria has been described as a life-threatening syndrome in COVID-19 patients [161]. It has been ascribed as an early-late manifestation in COVID-19, which can lead to acute renal injury [113,161]. Several hypotheses exist regarding the pathogenic mechanism of muscle manifestations in COVID-19 patients.…”

Section: Skeletal Muscle Manifestationsmentioning

confidence: 99%

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

et al. 2021

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The unremitting coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marked a year-long phase of public health adversaries and has severely compromised healthcare globally. Early evidence of COVID-19 noted its impact on the pulmonary and cardiovascular functions, while multiple studies in recent time shed light on its substantial neurological complications, though a comprehensive understanding of the cause(s), the mechanism(s), and their neuropathological outcomes is scarce. In the present review, we conferred evidence of neurological complications in COVID-19 patients and shed light on the SARS-CoV-2 infection routes including the hematogenous, direct/neuronal, lymphatic tissue or cerebrospinal fluid, or infiltration through infected immune cells, while the underlying mechanism of SARS-CoV-2 invasion to the central nervous system (CNS) was also discussed. In an up-to-date manner, we further reviewed the impact of COVID-19 in developing diverse neurologic manifestations associated with CNS, peripheral nervous system (PNS), skeletal muscle, and also pre-existing neurological diseases, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, and myasthenia gravis. Furthermore, we discussed the involvement of key factors including age, sex, comorbidity, and disease severity in exacerbating the neurologic manifestations in COVID-19 patients. An outlook of present therapeutic strategies and state of existing challenges in COVID-19 management was also accessed. Conclusively, the present report provides a comprehensive review of COVID-19-related neurological complications and emphasizes the need for their early clinical management in the ongoing COVID-19 pandemic. Keywords COVID-19 • SARS-CoV-2 • CNS • PNS • Neuroinvasion • COVID-19 pandemic • Neurological complications Highlights• Coronavirus disease 2019 (COVID-19)-associated complications involve substantial neurological manifestations.• SARS-CoV-2 infection routes include the hematogenous, neuronal, lymphatic tissue/cerebrospinal fluid, or infiltration through infected immune cells.• COVID-19 promotes neurologic manifestations associated with the central and peripheral nervous system and exacerbates the pre-existing neurological and neurodegenerative conditions. • Patient's age, sex, comorbidity, and severity of the infection are key factors that determine the extent of neurologic manifestations in COVID-19 patients.

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Section: Skeletal Muscle Manifestationsmentioning

confidence: 99%

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

et al. 2021

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“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for COVID-19, causes symptoms such as cough and fever, severe pneumonia, and death ( 3 ). Coronaviruses are enveloped, positive-stranded RNA viruses that belong to the Coronaviridae family and the order Nidovirales.…”

Section: Introductionmentioning

confidence: 99%

Mental health and fatigue status of the medical workforce during the COVID-19 outbreak in the Yangzhou city, China

Tang

Pei²,

Wang³

et al. 2022

Front. Psychiatry

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BackgroundWhen the coronavirus disease 2019 (COVID-19) erupted in Yangzhou, China, at the end of July 2021, medical workers in Yangzhou immediately joined the frontline for the fight against the pandemic. This study aimed to identify the mental health and fatigue experienced by the medical workers in Yangzhou during the COVID-19 outbreak.MethodsWe included 233 medical workers who participated in the front-line work for more than 1 month through the questionnaire, including doctors, nurses, medical technicians and medical students. The generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), and Fatigue self-assessment scale (FSAS) were administered to the participants and their responses were evaluated.ResultsA total of 233 eligible questionnaires were received. Among them, 130 people (57.08%) were probably anxious and 141 (60.52%) people were clinically depressed. Poor sleep was considered an independent risk factor for anxiety (OR = 7.164, 95% CI: 3.365 15.251, p = 0.000) and depression (OR = 6.899, 95% CI: 3.392 14.030, p = 0.000). A high PHQ-9 score was considered an independent risk factor for general fatigue (OR = 1.697, 95% CI: 1.481 1.944, p = 0.000). Mental fatigue (OR = 1.092, 95% CI: 1.027 1.161, p = 0.005) and fatigue response to sleep/rest (OR = 1.043, 95% CI: 1.011 1.076 p = 0.008) were considered independent risk factors for general fatigue.ConclusionPoor quality of sleep led to probable anxiety, depression, and general fatigue. Mental fatigue and fatigue response to sleep/rest were independent risk factors for depression, which merits attention for battling COVID-19.

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“…These alterations trigger the dysfunction of skeletal muscles. [ 6 , 20 , 21 ] Furthermore, due to hypoxemia, activation of osteoclasts cause an imbalance between bone formation and bone resorption. [ 6 ] Additionally, production of reactive oxygen species (ROS) are increased during hypoxia.…”

mentioning

confidence: 99%

Musculoskeletal involvement: COVID-19 and post COVID 19

Evcik¹

2023

Turk J Phys Med Rehab

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The worldwide pandemic of coronavirus disease 2019 (COVID-19) was known to predominantly affect the lungs, but it was realized that COVID-19 had a large variety of clinical involvement. Cardiovascular, gastrointestinal, neurological, and musculoskeletal systems are involved by direct or indirect mechanisms with various manifestations. The musculoskeletal involvement can manifest during COVID-19 infection, due to medications used for the treatment of COVID-19, and in the post/long COVID-19 syndrome. The major symptoms are fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain. During the last two years, musculoskeletal involvement increased, but no clear consensus was obtained about the pathogenesis. However, there is valuable data that supports the hypothesis of angiotensinconverting enzyme 2, inflammation, hypoxia, and muscle catabolism. Additionally, medications that were used for treatment also have musculoskeletal adverse effects, such as corticosteroid-induced myopathy and osteoporosis. Therefore, while deciding the drugs, priorities and benefits should be taken into consideration. Symptoms that begin three months from the onset of the COVID-19 infection, continue for at least two months, and cannot be explained by another diagnosis is accepted as post/long COVID-19 syndrome. Prior symptoms may persist and fluctuate, or new symptoms may manifest. In addition, there must be at least one symptom of infection. Most common musculoskeletal symptoms are myalgia, arthralgia, fatigue, back pain, muscle weakness, sarcopenia, impaired exercise capacity, and physical performance. In addition, the female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical ventilation, not having vaccination, and comorbid disorders can be accepted as clinical predictors for post/long COVID-19 syndrome. Musculoskeletal pain is also a major problem and tends to be in chronic form. There is no consensus on the mechanism, but inflammation and angiotensin-converting enzyme 2 seem to play an important role. Localized and generalized pain may occur after COVID-19, and general pain is at least as common as localized pain. An accurate diagnosis allows physicians to initiate pain management and proper rehabilitation programs.

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Neurological manifestations in COVID-19 and its possible mechanism

Cited by 5 publications

References 80 publications

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

Mental health and fatigue status of the medical workforce during the COVID-19 outbreak in the Yangzhou city, China

Musculoskeletal involvement: COVID-19 and post COVID 19

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