Spectrum, risk factors and outcomes of neurological complications of COVID-19

Abstract

functional correlate, we studied the blink reflex (BR) in 11 COVID-19 patients, admitted to our Intensive Care Unit (ICU), and compared data both with healthy subjects and non COVID-19 ICU patients. BR assesses a ponto-medullary circuitry partly involving the reticular formation (RF) close to the respiratory nuclei; RF itself modulates the activity of the respiratory centers. An extensive neurological examination, comprising the corneal and glabellar reflexes, was also performed. ResultsAutopsies showed a high percentage of neuronal damage and a higher number of CA in the medulla oblongata of COVID-19 patients; immunohistochemistry revealed the presence of SARS-Cov-2 virus in the brainstem (Fig. 1). Neurophysiologically, the medullary RII component of the BR was selectively impaired in COVID-19 and, clinically, the glabellar reflex severely impaired or absent. ConclusionsOur findings provide the neuropathological, neurophysiological and clinical evidence of SARS-Cov-2-related brainstem involvement, suggesting a neurogenic component of respiratory failure.