Neurological manifestations of COVID-19: a clinical approach
DOI:
https://doi.org/10.13181/mji.rev.204821Keywords:
COVID-19, neurological manifestations, SARS-CoV-2Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 which attacks the respiratory tract and has been declared a global pandemic by the World Health Organization. The disease has a very wide clinical spectrum which can be manifested as asymptomatic to critical conditions. SARS-CoV-2 shows a neurotropism proven by its identification in the cerebrospinal fluid and brain vascular endothelial. The complete mechanism of how the virus invades the human nervous system is yet to be identified. Thus, every neurologist needs to follow the progressivity of COVID-19 symptoms involving the nervous system.
Downloads
References
World Health Organization (WHO). Coronavirus disease (COVID-19) pandemic. World Health Organization (WHO); 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
Docea AO, Tsatsakis A, Albulescu D, Cristea O, Zlatian O, Vinceti M, et al. A new threat from an old enemy: re-emergence of coronavirus (review). Int J Mol Med. 2020;45(6):1631-43. https://doi.org/10.3892/ijmm.2020.4555
Kang S, Peng W, Zhu Y, Lu S, Zhou M, Lin W, et al. Recent progress in understanding 2019 novel coronavirus (SARS-CoV-2) associated with human respiratory disease: detection, mechanisms and treatment. Int J Antimicrob Agents. 2020;55(5):105950. https://doi.org/10.1016/j.ijantimicag.2020.105950
Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;133(9):1025-31. https://doi.org/10.1097/CM9.0000000000000744
Wang HY, Li XL, Yan ZR, Sun XP, Han J, Zhang BW. Potential neurological symptoms of COVID-19. Ther Adv Neurol Disord. 2020;13. https://doi.org/10.1177/1756286420917830
De Felice FG, Tovar-Moll F, Moll J, Munoz DP, Ferreira ST. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the central nervous system. Trends Neurosci. 2020;43(6):355-7. https://doi.org/10.1016/j.tins.2020.04.004
Needham EJ, Chou SH, Coles AJ, Menon DK. Neurological implications of COVID-19 infections. Neurocrit Care. 2020;32(3):667-71. https://doi.org/10.1007/s12028-020-00978-4
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90. https://doi.org/10.1001/jamaneurol.2020.1127
Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents. 2020;55(5):105955. https://doi.org/10.1016/j.ijantimicag.2020.105955
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207. https://doi.org/10.1056/NEJMoa2001316
Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020;7(1):11. https://doi.org/10.1186/s40779-020-00240-0
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. https://doi.org/10.1136/bmj.m1091
Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020;92(4):441-7. https://doi.org/10.1002/jmv.25689
Wu Y, Xu X, Yang L, Liu C, Yang C. Nervous system damage after COVID-19 infection: presence or absence? Brain Behav Immun. 2020;87:55. https://doi.org/10.1016/j.bbi.2020.04.043
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-20. https://doi.org/10.1056/NEJMoa2002032
Rabi FA, Al Zoubi MS, Kasasbeh GA, Salameh DM, Al-Nasser AD. SARS-CoV-2 and coronavirus disease 2019: what we know so far. Pathogens. 2020;9(3):231. https://doi.org/10.3390/pathogens9030231
Borges do Nascimento IJ, Cacic N, Abdulazeem HM, von Groote TC, Jayarajah U, Weerasekara I, et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med. 2020;9(4):941. https://doi.org/10.3390/jcm9040941
Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, et al. A first case of meningitis/encephalitis associated with SARS-coronavirus-2. Int J Infect Dis. 2020;94:55-8. https://doi.org/10.1016/j.ijid.2020.03.062
Jin H, Hong C, Chen S, Zhou Y, Wang Y, Mao L, et al. Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke Vasc Neurol. 2020;5(2):146-51. https://doi.org/10.1136/svn-2020-000382
Lechien JR, Chiesa-Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al. Clinical and epidemiological characteristics of 1,420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med. 2020;288(3):335-44. https://doi.org/10.1111/joim.13089
Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020;382(23):2268-70. https://doi.org/10.1056/NEJMc2008597
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID 19: a single center retrospective, observational study. Stroke Vasc Neurol. 2020;5(3):279-84. https://doi.org/10.1136/svn-2020-000431
Craen A, Logan G, Ganti L. Novel coronavirus disease 2019 and subarachnoid hemorrhage: a case report. Cureus. 2020;12(4):e7846. https://doi.org/10.7759/cureus.7846
Guidon AC, Amato AA. COVID-19 and neuromuscular disorders. Neurology. 2020;94(22):959-69. https://doi.org/10.1212/WNL.0000000000009566
Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002-9. https://doi.org/10.1136/gutjnl-2020-320926
Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020;277(8):2251-61. https://doi.org/10.1007/s00405-020-05965-1
Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis. 2020;71(15):889-90. https://doi.org/10.1093/cid/ciaa330
Paniz-Mondolfi A, Bryce C, Grimes Z, Gordon RE, Reidy J, Lednicky J, et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). J Med Virol. 2020;92(7):699-702. https://doi.org/10.1002/jmv.25915
Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun. 2020;88:945-6. https://doi.org/10.1016/j.bbi.2020.04.017
Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of covid-19 in the young. N Engl J Med. 2020;382(20):e60. https://doi.org/10.1056/NEJMc2009787
Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. Guillain-Barré syndrome related to COVID-19 infection. Neurol Neuroimmunol Neuroinflamm. 2020;7(4):e741. https://doi.org/10.1212/NXI.0000000000000741
Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020;19(5):383-4. https://doi.org/10.1016/S1474-4422(20)30109-5
Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med. 2020:NEJMc2009191. https://doi.org/10.1056/NEJMc2009191
Virani A, Rabold E, Hanson T, Haag A, Elrufay R, Cheema T, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection. IDCases. 2020;20:e00771. https://doi.org/10.1016/j.idcr.2020.e00771
Gutiérrez-Ortiz C, Méndez-Guerrero A, Rodrigo-Rey S, Pedro-Murillo ES, Bermejo-Guerrero L, Gordo-Mañas R, et al. Miller Fisher syndrome and polyneuritis cranialis in COVID-19. Neurology. 2020;95(5). https://doi.org/10.1212/WNL.0000000000009619
Barzegar M, Mirmosayyeb O, Nehzat N, Sarrafi R, Khorvash F, Maghzi AH, et al. COVID-19 infection in a patient with multiple sclerosis treated with fingolimod. Neurol Neuroimmunol Neuroinflamm. 2020;7(4). https://doi.org/10.1212/NXI.0000000000000753
Delly F, Syed MJ, Lisak RP, Zutshi D. Myasthenic crisis in COVID-19. J Neurol Sci. 2020;414:116888. https://doi.org/10.1016/j.jns.2020.116888
Su S, Wong G, Shi W, Liu J, Lai AC, Zhou J, et al. epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol. 2016;24(6):490-502. https://doi.org/10.1016/j.tim.2016.03.003
Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020;11(7):995-8. https://doi.org/10.1021/acschemneuro.0c00122
Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-6. https://doi.org/10.1016/j.ijid.2020.01.009
Koyuncu OO, Hogue IB, Enquist LW. Virus infections in the nervous system. Cell Host Microbe. 2013;13(4):379-93. https://doi.org/10.1016/j.chom.2013.03.010
Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review. JAMA Neurol. 2020;77(8):1018-27. https://doi.org/10.1001/jamaneurol.2020.2065
Xia H, Lazartigues E. Angiotensin-converting enzyme 2 in the brain: properties and future directions. J Neurochem. 2008;107(6):1482-94. https://doi.org/10.1111/j.1471-4159.2008.05723.x
Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;1-4. https://doi.org/10.1002/jmv.25728
Marchioni E, Minoli L. Headache attributed to infections nosography and differential diagnosis. Handb Clin Neurol. 2010;97:601-26. https://doi.org/10.1016/S0072-9752(10)97052-8
Zhou Z, Kang H, Li S, Zhao X. Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol. 2020:1-6. https://doi.org/10.1007/s00415-020-09929-7
Gladstone J, Bigal ME. Headaches attributable to infectious diseases. Curr Pain Headache Rep. 2010;14(4):299-308. https://doi.org/10.1007/s11916-010-0125-7
Li YC, Bai WZ, Hashikawa T. Response to commentary on "The neuroinvasive potential of SARS-CoV-2 may play a role in the respiratory failure of COVID-19 patients". J Med Virol. 2020;92(7):707-9. https://doi.org/10.1002/jmv.25824
Tyler KL. Acute viral encephalitis. N Engl J Med. 2018;379(6):557-66. https://doi.org/10.1056/NEJMra1708714
Ellul M, Solomon T. Acute encephalitis - diagnosis and management. Clin Med (Lond). 2018;18(2):155-9. https://doi.org/10.7861/clinmedicine.18-2-155
Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2019;12(1):14. https://doi.org/10.3390/v12010014
Bookstaver PB, Mohorn PL, Shah A, Tesh LD, Quidley AM, Kothari R, et al. Management of viral central nervous system infections: a primer for clinicians. J Cent Nerv Syst Dis. 2017;9:1179573517703342. https://doi.org/10.1177/1179573517703342
Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18-22. https://doi.org/10.1016/j.bbi.2020.03.031
Baig AM. Neurological manifestations in COVID-19 caused by SARS-CoV-2. CNS Neurosci Ther. 2020;26(5):499-501. https://doi.org/10.1111/cns.13372
Li Z, Liu T, Yang N, Han D, Mi X, Li Y, et al. Neurological manifestations of patients with COVID-19: potential routes of SARS-CoV-2 neuroinvasion from the periphery to the brain. Front Med. 2020;14(5):533-41. https://doi.org/10.1007/s11684-020-0786-5
Serrano-Castro PJ, Estivill-Torrús G, Cabezudo-García P, Reyes-Bueno JA, Ciano Petersen N, Aguilar-Castillo MJ, et al. Impact of SARS-CoV-2 infection on neurodegenerative and neuropsychiatric diseases: a delayed pandemic? Neurologia. 2020;35(4):245-51. https://doi.org/10.1016/j.nrl.2020.04.002
Du W, Yu J, Wang H, Zhang X, Zhang S, Li Q, et al. Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China. Infection. 2020:1-8. https://doi.org/10.21203/rs.3.rs-17119/v1
Swanson PA II, McGavern DB. Viral diseases of the central nervous system. Curr Opin Virol. 2015;11:44-54. https://doi.org/10.1016/j.coviro.2014.12.009
Desforges M, Le Coupanec A, Stodola JK, Meessen-Pinard M, Talbot PJ. Human coronaviruses: viral and cellular factors involved in neuroinvasiveness and neuropathogenesis. Virus Res. 2014;194:145-58. https://doi.org/10.1016/j.virusres.2014.09.011
Benameur K, Agarwal A, Auld SC, Butters MP, Webster AS, Ozturk T, et al. Encephalopathy and encephalitis associated with cerebrospinal fluid cytokine alterations and coronavirus disease, Atlanta, Georgia, USA, 2020. Emerg Infect Dis. 2020;26(9):2016-21. https://doi.org/10.3201/eid2609.202122
Markus HS, Brainin M. COVID-19 and stroke-A global World Stroke Organization perspective. Int J Stroke. 2020;15(4):361-4. https://doi.org/10.1177/1747493020923472
Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71(15):762-8. https://doi.org/10.1093/cid/ciaa248
McGonagle D, Sharif K, O'Regan A, Bridgewood C. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev. 2020;19(6):102537. https://doi.org/10.1016/j.autrev.2020.102537
Pérez CA. Looking ahead: the risk of neurologic complications due to COVID-19. Neurol Clin Pract. 2020;10(4):371-4. https://doi.org/10.1212/CPJ.0000000000000836
Saavedra JM. COVID-19, angiotensin receptor blockers, and the brain. Cell Mol Neurobiol. 2020;40(5):667-74. https://doi.org/10.1007/s10571-020-00861-y
Speth MM, Singer-Cornelius T, Obere M, Gengler I, Brockmeier SJ, Sedaghat AR. Olfactory dysfunction and sinonasal symptomatology in COVID-19: prevalence, severity, timing, and associated characteristics. Otolaryngol Head Neck Surg. 2020;163(1):114-20. https://doi.org/10.1177/0194599820929185
Netland J, Meyerholz DK, Moore S, Cassell M, Perlman S. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol. 2008;82(15):7264-75. https://doi.org/10.1128/JVI.00737-08
Bolay H, Gül A, Baykan B. COVID-19 is a real headache! Headache. 2020;60(7):1415-21. https://doi.org/10.1111/head.13856
Wilson MP, Jack AS. Coronavirus disease 2019 (COVID-19) in neurology and neurosurgery: a scoping review of the early literature. Clin Neurol Neurosurg. 2020;193:105866. https://doi.org/10.1016/j.clineuro.2020.105866
Federico A. Experiencing COVID19 pandemic and neurology: learning by the recent reports and by old literary or scientific descriptions. Neurol Sci. 2020;41(6):1323-7. https://doi.org/10.1007/s10072-020-04471-w
Moazzami B, Razavi-Khorasani N, Dooghaie Moghadam A, Farokhi E, Rezaei N. COVID-19 and telemedicine: immediate action required for maintaining healthcare providers well-being. J Clin Virol. 2020;126:104345. https://doi.org/10.1016/j.jcv.2020.104345
Al Hussona M, Maher M, Chan D, Micieli JA, Jain JD, Khosravani H, et al. the virtual neurologic exam: instructional videos and guidance for the COVID-19 era. Can J Neurol Sci. 2020;47(5):598-603. https://doi.org/10.1017/cjn.2020.96
Pollett S, Rivers C. Social media and the new world of scientific communication during the COVID19 pandemic. Clin Infect Dis. 2020;71(16):2184-6. https://doi.org/10.1093/cid/ciaa553
Orsucci D, Lenco EC, Nocita G, Napolitano A, Vista M. Neurological features of COVID-19 and their treatment: a review. Drugs Context. 2020;9:2020-5-1. https://doi.org/10.7573/dic.2020-5-1
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.