Neurological Manifestations of SARS-CoV-2

Abstract

Background: Coronavirus disease 2019 (COVID-19) pandemic started as an outbreak in China and soon crossed borders to affect the populations in all countries of the world. During the initial course of the disease, COVID-19 was perceived as a pneumonia-like illness. However, recent findings of COVID-19 patients suggest that the virus has the potential to disseminate to different tissues and organs, and cause significant complications. Summary: Neurological symptoms are of great significance as these usually present in and complicate critical cases. Many case reports and case series have documented the findings of neurological complications in COVID-19 patients. From the existing data, the most frequent symptoms in these patients were broadly classified into the central nervous system (CNS), peripheral nervous system, and skeletal muscular symptoms. CNS symptoms include meningitis, encephalitis, cerebrovascular complications, peripheral nervous system symptoms include anosmia, ageusia, and skeletal muscular symptoms include myalgias. It is postulated that the cause may be direct CNS injury through blood and neuronal pathways or indirectly because of an immune-mediated response, hypoxia caused by decreased oxygen saturation, or by the binding of subacute respiratory syndrome-coronavirus-2 to the host angiotensin-converting enzyme-2 receptors. Striking radiologic findings in COVID-19 patients with neurological symptoms have also emerged. Conclusions: As subacute respiratory syndrome-coronavirus-2 may potentially have lethal implications on the nervous system, it is important that neurologists are better informed about the spectrum of clinical manifestations, radiologic findings, and likely mechanisms of injury. Understanding the symptoms and radiologic imaging allows clinicians to consider brain imaging in any patient with suspected COVID-19 and neurological symptoms.

Cognitive Impairment After COVID-19—A Review on Objective Test Data

“…A letter dating from June 2020 ( 12 ) reported that a third of their discharged COVID-19 patients showed a dysexecutive syndrome consisting of “inattention, disorientation, or poorly organized movements in response to command” (Third paragraph). As more unusual symptoms emerged it became gradually clear that COVID-19 could affect a wide variety of organs and tissue ( 13 – 15 ).…”

The Adverse Outcome Pathway Framework Applied to Neurological Symptoms of COVID-19

“…However, these findings do not imply that the nervous system is only directly affected by SARS-CoV-2. Indirect effects on the central and peripheral nervous system through injury to other organ systems are also reported [ 169 ]. Some underlying conditions and risk factors have been linked to the severity of the reported neuropathological conditions that may partially explain the selectivity in certain patients infected by SARS-CoV-2.…”

The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

“…We observed that several articles within this category reviewed the neurological manifestations and complications of severe COVID-19, reporting skeletal muscle damage associated with myalgia and elevated levels of CK in severely ill patients ( Ahmad and Rathore, 2020 ; Benny and Khadilkar, 2020 ; Drożdżal et al, 2020 ; Fotuhi et al, 2020 ; Khan et al, 2020 ; Nepal et al, 2020 ; Pinzon et al, 2020 ; Puccioni-Sohler et al, 2020 ; Sheraton et al, 2020 ; Andalib et al, 2021 ; Harapan and Yoo, 2021 ; Moghimi et al, 2021 ; Orsucci et al, 2021 ; Quraishi et al, 2021 ). It was also reported cases of muscle pain associated with muscle denervation atrophy, suggesting Guillain-Barré syndrome, an autoimmune peripheral nervous system disease, as a sequel of the SARS-CoV-2 infection ( Aksan et al, 2020 ; Bahouth et al, 2021 ; Meyer-Frießem et al, 2021 ).…”