Neurologic Complications in Adult and Pediatric Patients with SARS-CoV-2 Infection

Kendall Howard,Elizabeth Fitch,Zelda Ghersin,Esther Pototskiy,Taylor Williams,Alberto E Musto,Heather Ots,Jay Hawkshead

doi:10.3390/ctn6010001

Abstract

SARS-CoV-2 has an impact on the nervous system as a result of pathological cellular and molecular events at the level of vascular and neural tissue. Severe neurologic manifestations including stroke, ataxia, seizure, and depressed level of consciousness are prevalent in patients with SARS-CoV-2 infection. Although the mechanism is still unclear, SARS-CoV-2 has been associated with the pathogenesis of intravascular coagulation and angiotensin-converting enzyme-I, both exacerbating systemic inflammation and contributing to hypercoagulation or blood–brain barrier leakage, resulting in ischemic or hemorrhagic stroke. On the other hand, the SARS-CoV-2 spike protein in neural tissue and within the cerebrospinal fluid may induce neural dysfunction, resulting in neuroinflammation, which is exacerbated by peripheral and neural hypercytokinemia that can lead to neuronal damage and subsequent neuroinflammation. A deeper understanding of the fundamental biological mechanisms of neurologic manifestations in SARS-CoV-2 infection can pave the way to identifying a single biomarker or network of biomarkers to help target neuroprotective therapy in patients at risk for developing neurological complications.

Highlights

While society is still grappling with the acute effects of the COVID-19 pandemic, the long-term sequelae from the illness remain largely unknown
In a study of 1695 hospitalized pediatric patients admitted with either acute COVID-19 pneumonia or multi-system inflammatory syndrome in children (MIS-C), the majority (88%) of children developed transient neurologic complications that resolved by the time of discharge, 12% of hospitalized patients developed life-threatening neurologic complications [26]
Initial studies reported the presence of the COVID-19 spike protein (S1) within olfactory nerves as well as viral mRNA samples within the cerebrospinal fluid, suggesting that the virus may be able to enter the central nervous system and induce neural dysfunction with resulting neuroinflammation [29]

Summary

Introduction

While society is still grappling with the acute effects of the COVID-19 pandemic, the long-term sequelae from the illness remain largely unknown. A multicenter study of children hospitalized with either acute COVID-19 or multi-system inflammatory syndrome in children (MIS-C) documented 22% of pediatric cases with neurological involvement, including 12% who developed life threatening neurologic complications [22]. The purpose of this critical review is to summarize current mechanistic theories of neurologic complications in both adult and pediatric patients with SARS-CoV-2 infection. A deeper understanding of the mechanisms behind these manifestations can lead to targeted therapeutic interventions and improved patient outcomes

Neural Tissue

Blood Vessels

Findings

Conclusions