Neurological Manifestations of COVID-19 (SARS-CoV-2): A Review.

Muhammad Umer Ahmed,Abdul Sattar,Amin H Karim,Muhammad Hanif,Mukarram Jamat Ali,Danish Kherani,Gul Muhammad Memon,Muhammad Adnan Haider

doi:10.3389/fneur.2020.00518

Abstract

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with many neurological symptoms but there is a little evidence-based published material on the neurological manifestations of COVID-19. The purpose of this article is to review the spectrum of the various neurological manifestations and underlying associated pathophysiology in COVID-19 patients.Method: We conducted a review of the various case reports and retrospective clinical studies published on the neurological manifestations, associated literature, and related pathophysiology of COVID-19 using PUBMED and subsequent proceedings. A total of 118 articles were thoroughly reviewed in order to highlight the plausible spectrum of neurological manifestations of COVID 19. Every article was either based on descriptive analysis, clinical scenarios, correspondence, and editorials emphasizing the neurological manifestations either directly or indirectly. We then tried to highlight the significant plausible manifestations and complications that could be related to the pandemic. With little known about the dynamics and the presentation spectrum of the virus apart from the respiratory symptoms, this area needs further consideration.Conclusion: The neurological manifestations associated with COVID-19 such as Encephalitis, Meningitis, acute cerebrovascular disease, and Guillain Barré Syndrome (GBS) are of great concern. But in the presence of life-threatening abnormal vitals in severely ill COVID-19 patients, these are not usually underscored. There is a need to diagnose these manifestations at the earliest to limit long term sequelae. Much research is needed to explore the role of SARS-CoV-2 in causing these neurological manifestations by isolating it either from cerebrospinal fluid or brain tissues of the deceased on autopsy. We also recommend exploring the risk factors that lead to the development of these neurological manifestations.

Highlights

GENOME OF SARS-CoV-2The new public health pandemic COVID-19 is threatening the world with the outbreak of the novel corona virus (2019nCOV) or severe acute respiratory syndrome corona virus 2 (SARS-CoV-2)
Li et al proposed that the acute respiratory failure that occurs in COVID-19 patients could be partly because of the damage to the brain stem caused by SARSCoV-2, in addition to direct damage to lungs [5]. It raises a question over how SARS-CoV-2 enters brain? In this review article we present the possible mechanisms used by SARS-CoV2 in causing the neurological presentations of COVID-19 by summarizing and recollecting different material published over time in this regard
Olfactory and gustatory dysfunction were more common in females as compare to males (p < 0.0001) which highlights a gender predisposition [46]

Summary

Introduction

GENOME OF SARS-CoV-2The new public health pandemic COVID-19 is threatening the world with the outbreak of the novel corona virus (2019nCOV) or severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). In December 2019, a new virus epidemic in Wuhan, China (covid-19) [1] emerged as a world pandemic and has disseminated across many other countries [2]. It has been declared a public health emergency by WHO. As of statistics obtained from Worldometer on April 11, 2020, the USA leads with over 0.5 million people infected, followed by Spain and Italy The spread of this virus shows no evidence of plateauing and the economic, financial, social, and mental havoc along with severe lockdown measures is of great concern. The purpose of this article is to review the spectrum of the various neurological manifestations and underlying associated pathophysiology in COVID-19 patients

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