SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation

Keyhanian, Kiandokht; Umeton, Raffaella Pizzolato; Mohit, Babak; Davoudi, Vahid; Hajighasemi, Fatemeh; Ghasemi, Mehdi

doi:10.1016/j.jneuroim.2020.577436

Cited by 121 publications

(164 citation statements)

References 207 publications

(228 reference statements)

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“…Current literature suggests that neurological symptoms and manifestations resulting from COVID-19 can occur prior, during, and even after respiratory involvement [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

2021

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and was first identified in Wuhan, China in December 2019. It is evident that the COVID-19 pandemic has become a challenging world issue. Although most COVID-19 patients primarily develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with COVID-19 have been observed. In this narrative review, we elaborate on proposed neurotropic mechanisms and various neurological symptoms, manifestations, and complications of COVID-19 reported in the present literature. For this purpose, a review of all current published literature (studies, case reports, case series, reviews, editorials, and other articles) was conducted and neurological sequelae of COVID-19 were summarized. Essential and common neurological symptoms including gustatory and olfactory dysfunctions, myalgia, headache, altered mental status, confusion, delirium, and dizziness are presented separately in sections. Moreover, neurological manifestations and complications that are of great concern such as stroke, cerebral (sinus) venous thrombosis, seizures, meningoencephalitis, Guillain–Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome (PRES) are also addressed systematically. Future studies that examine the impact of neurological symptoms and manifestations on the course of the disease are needed to further clarify and assess the link between neurological complications and the clinical outcome of patients with COVID-19. To limit long-term consequences, it is crucial that healthcare professionals can early detect possible neurological symptoms and are well versed in the increasingly common neurological manifestations and complications of COVID-19.

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“…Current literature suggests that neurological symptoms and manifestations resulting from COVID-19 can occur prior, during, and even after respiratory involvement [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

2021

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“…Approximately 37% of CARDS patients present with neurological symptoms ranging from mild (fatigue/malaise, headache, dizziness, anosmia, and myalgia) to severe [ 23 , 146 , 147 ]. With both central and peripheral nervous systems involved [ 23 ], it is now increasingly understood that neurological SARS-CoV-2-associated symptoms considerably impact patient outcomes [ 22 , 23 , 147 ]. Proposed mechanisms of SARS-CoV-2-associated neurological injury include direct injury as well as neuroinflammation, myelitis, meningoencephalitis, encephalopathy, and others [ 23 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…With both central and peripheral nervous systems involved [ 23 ], it is now increasingly understood that neurological SARS-CoV-2-associated symptoms considerably impact patient outcomes [ 22 , 23 , 147 ]. Proposed mechanisms of SARS-CoV-2-associated neurological injury include direct injury as well as neuroinflammation, myelitis, meningoencephalitis, encephalopathy, and others [ 23 ]. However, while a delirium can be observed in many cases in the later phase of CARDS (personal observations), exact underlying mechanisms appear unclear.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Furthermore, like many other viral diseases, autoimmune disease can be triggered. This includes Guillan-Barreé syndromes (GBS), which are characterized by acute ascending muscular weakness accompanied by decreased and/or absent deep tendon reflexes [ 23 ]. SARS-CoV-2 is known to trigger GBS.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…However, as currently there is no evidence proven and disease-specific medical treatment (despite potential beneficial effects of corticosteroids) available, current intensive care treatment for CARDS is mostly symptomatic/supportive and in line with ARDS recommendations. In addition, despite severe hypoxemic respiratory failure, severe COVID-19 may be associated with additional organ dysfunctions, including cardiac/cardiovascular [ 20 , 21 ], neurological/cerebrovascular [ 22 , 23 ], and/or renal dysfunction [ [24] , [25] , [26] ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

Pfortmueller

Spinetti

Urman

et al. 2021

Best Practice & Research Clinical Anaesthesiology

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Guillain–Barré Syndrome Variant Occurring after SARS‐CoV‐2 Vaccination

Allen

Ramsamy

Tarr

et al. 2021

Annals of Neurology

153

144

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Although SARS-CoV-2 vaccines are very safe, we report 4 cases of the bifacial weakness with paresthesias variant of Guillain-Barré syndrome (GBS) occurring within 3 weeks of vaccination with the Oxford-AstraZeneca SARS-CoV-2 vaccine. This rare neurological syndrome has previously been reported in association with SARS-CoV-2 infection itself. Our cases were given either intravenous immunoglobulin, oral steroids, or no treatment. We suggest vigilance for cases of bifacial weakness with paresthesias variant GBS following vaccination for SARS-CoV-2 and that postvaccination surveillance programs ensure robust data capture of this outcome, to assess for causality.

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SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation

Cited by 121 publications

References 207 publications

Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

Guillain–Barré Syndrome Variant Occurring after SARS‐CoV‐2 Vaccination

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