Post-COVID 19 neurological syndrome: Implications for sequelae’s treatment

Abstract

Study design Literature review. Objectives Describe the implications of post-COVID syndrome due to neurological sequelae including treatment and the differences that may exist between this group of patients and those who present these events not associated with COVID-19. Methods A non-systematic review of the literature was carried out in PubMed and Science Direct databases, using the keywords “Post-acute COVID-19 syndrome”; “Neurological complications”; “Neurologic Manifestations” “COVID-19″ and ”Rehabilitation“, as well as synonyms, which were combined with the operators ”AND“ and ”OR“. Results The COVID-19 viral caustive agent, SARS-CoV-2, has a high affinity for human angiotensin-converting enzyme 2 receptor on type II pneumocytes. This receptor is also expressed in neurons and glial cells. Based on the foregoing and other not so clear mechanisms, it is stated that SARS-CoV-2 has tropism for the nervous system, being evident through the neurological manifestations observed in patients with mild, moderate and severe phenotype of the disease such as anosmia, ageusia, headache, cerebrovascular accidents, Guillain-Barré syndrome, seizures, and encephalopathy. This can generate severe sequelae and even fatal outcomes in those affected. Conclusions Neurological complications caused by COVID-19 are frequent and represent a risk that compromises the functional capacity and the life of patients. The suspicion of these conditions, the strict control of metabolic alterations and cardiovascular risk factors, the effective and safe treatment of these entities, are a current challenge throughout the pandemic. The rehabilitation process in these patients is a challenge. This is due to the limitations generated by multi-organ damage, as well as risk of brain death.

Letter to the Editor regarding “Missed cerebrovascular events during prolonged sedation for COVID-19 pneumonia”

“…Although there is overwhelming evidence on pathophysiological descriptions [8], correlations between comorbidities and outcomes among the different types of COVID-19 phenotypes [5,6], and even multicenter registries on neurological involvement in this type of patients [9], the information presented in the study by Bruce et al [1], confirms that there is still much that is unknown about the management, prevention and early diagnosis of COVID-19 complications. Nervous tissue is one of the few tissues that need to be protected with great care, since its affectation represents morbidity, mortality and disability, as well as high costs in neurorehabilitation [7]. Strengthening healthcare systems and reevaluating COVID-19 management algorithms for critically ill patients, as well as persistent research, are critical to answering the questions that currently haunt the neurological integrity of these patients.…”

“…However, this question may be the answer to a possible massive under-registration of deaths, where COVID-19 is registered as the cause of death in cases where it is not the final cause of death. In addition, it is necessary to take into account a bias that the authors innocently reveal, and that is the fact that considering that the average diagnosis of major neurovascular injury is 16 days, autopsies performed in patients who died within the average time of evolution during the critical period of this disease, compared to those who extend the time, may exhibit nerve injury [6] , which would be compatible with the severity of the manifestations of post-COVID-19 neurological syndrome presented by those patients who recover from a severe condition [7] . Therefore, the presence of nerve injury should be systematically evaluated in all patients with moderate or severe COVID-19 phenotype.…”

Letter to the editor regarding “Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period”

“…Post-COVID-19 neurological syndrome was recently described [2] , [3] , characterized by the persistence of neurological symptoms or development of mild or severe acute neurological events following the active phase of COVID-19, leading to high rates of morbidity, mortality, disability and health care costs [2] , [3] , [4] . It is a challenge to define neurological syndrome post-COVID 19, since most of the patients who develop neuroinflammation due to the infection are elderly people with cardiometabolic and neurovascular risk factors, making it difficult to differentiate the etiology precisely [4] .…”

“…This is even more complex in young patients with severe phenotype development of COVID-19, who may present with cryptogenic stroke during hospital stay or in the short term after the acute phase of COVID-19 [5] . One of the major concerns and that should be a primary objective today, is the careful approach and rehabilitation in this type of patients, who may lose functional capacity due to difficulties in physical therapy, neurocognitive, nutritional, psychological and neurophysiological, due to prolonged stay in intensive care [2] , [3] .…”

Respiratory function assessment at the time of a new respiratory virus pandemic

“…The limits of the results are intrinsically linked to the protocol itself and they were unavoidable: 1) the lack of standard lung function assessment, banned at that period[ 7 ]; 2) the lack of evaluation during some exercise task, due to patients suffering from important unexpected locomotor impairments[ 16 , 17 , 18 ], that were the primary question of the clinicians; 3) the low number of patients, due to the delicate period to gather people in a research laboratory, that was re-opened for that purpose at the end of a rigid national lockdown[ 19 ].…”