The neurology of COVID-19 revisited: A proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries

Abstract

A comprehensive review of the neurological disorders reported during the current COVID-19 pandemic demonstrates that infection with SARS-CoV-2 affects the central nervous system (CNS), the peripheral nervous system (PNS) and the muscle. CNS manifestations include: headache and decreased responsiveness considered initial indicators of potential neurological involvement; anosmia, hyposmia, hypogeusia, and dysgeusia are frequent early symptoms of coronavirus infection. Respiratory failure, the lethal manifestation of COVID-19, responsible for 264,679 deaths worldwide, is probably neurogenic in origin and may result from the viral invasion of cranial nerve I, progressing into rhinencephalon and brainstem respiratory centers. Cerebrovascular disease, in particular large-vessel ischemic strokes, and less frequently cerebral venous thrombosis, intracerebral hemorrhage and subarachnoid hemorrhage, usually occur as part of a thrombotic state induced by viral attachment to ACE2 receptors in endothelium causing widespread endotheliitis, coagulopathy, arterial and venous thromboses. Acute hemorrhagic necrotizing encephalopathy is associated to the cytokine storm. A frontal hypoperfusion syndrome has been identified. There are isolated reports of seizures, encephalopathy, meningitis, encephalitis, and myelitis. The neurological diseases affecting the PNS and muscle in COVID-19 are less frequent and include Guillain-Barré syndrome; Miller Fisher syndrome; polyneuritis cranialis; and rare instances of viral myopathy with rhabdomyolysis. The main conclusion of this review is the pressing need to define the neurology of COVID-19, its frequency, manifestations, neuropathology and pathogenesis. On behalf of the World Federation of Neurology we invite national and regional neurological associations to create local databases to report cases with neurological manifestations observed during the ongoing pandemic. International neuroepidemiological collaboration may help define the natural history of this worldwide problem.

The Effects of COVID-19 and Quarantine Measures on the Lifestyles and Mental Health of People Over 60 at Increased Risk of Dementia

“…COVID-19 can have direct and indirect effects on physical and mental health of the aged people. The SARS-CoV-2 virus which causes COVID-19 may affect central and peripheral nervous system ( 3 , 4 ), having potential effects on the development and progression of neurodegenerative diseases ( 5 ). SARS-CoV-2 may also affect the cells of the intestinal mucosa, triggering intestinal inflammation and dysbiosis and potentially causing short and long-term alterations of gut microbiota, which have demonstrated strong associations with, neuroinflammation and neurodegenerative diseases ( 6 , 7 ).…”

COVID-19 and Respiratory System Disorders

“… 64 , 65 , 110 Regarding the latter, experimental studies suggest that viral invasion of the olfactory nerve progression into the brain stem respiratory centers could be a potential mechanism for central nervous system involvement in the manifestation of respiratory failure related to coronaviruses. 111 Although evidence regarding SARS-CoV-2 is still scarce, coronavirus infections in the brain have been described before in both animal and human studies. 112 In mice transgenic for human ACE2, SARS-CoV-1 enters the brain via the olfactory bulb, and infection results in rapid, transneuronal spread to connected regions.…”

In Reply to the Letter to the Editor Regarding “Neurological Impact of Coronavirus Disease (COVID-19): Practical Considerations for the Neuroscience Community”

“…13,14 Despite this, the accumulating data documenting neurologic involvement in patients with COVID-19 [11][12][13] have fueled an increasing interest in the neuropathological research of postmortem tissue. 15 As we discussed, SARS-CoV-2 genetic material has been isolated from cerebrospinal fluid, even in cases in which oropharyngeal swab testing was negative for the virus. 16 Mishra et al 1 reported that the comorbidities appear to be associated with severe COVID-19 and with cerebrovascular accidents associated with severe disease.…”