Neurologic Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Abstract

This article describes the spectrum of neurologic complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, their underlying pathology and pathogenic mechanisms, gaps in knowledge, and current therapeutic strategies. COVID-19 is the clinical syndrome caused by the novel coronavirus SARS-CoV-2. It can affect the entire neuraxis, and presentations in the acute phase are variable, although anosmia is a common manifestation. Encephalopathy is common in patients who are hospitalized and is often associated with multiorgan involvement. Immune-mediated encephalitis is probably underrecognized; however, viral encephalitis is rare. Other manifestations include stroke, seizures, myelitis, and peripheral neuropathies, including Guillain-Barré syndrome, which sometimes has atypical manifestations. Treatment is symptomatic, and immunotherapies have been used successfully in some patients. Long-term complications include dysautonomia, exercise intolerance, malaise, sleep disturbances, cognitive impairment, and mood disorders. Neurologic manifestations of COVID-19 may occur in the acute setting and may be independent of respiratory manifestations. Immune-mediated syndromes and cerebrovascular complications are common. Large populations of patients are expected to have long-term neurologic complications of COVID-19, many of which may emerge only after recovery from the acute illness.