Neurological Manifestations Of COVID-19 Research Articles

Neurological manifestations of COVID-19: A narrative review

Many studies done during this pandemic revealed several neurological manifestations related to coronavirus disease 2019 or COVID-19 infection. The aim of this narrative review is to discuss the neurological manifestations and complications of COVID-19 disease.

Neurological presentation of COVID-19: Experience from a tertiary care hospital of Bangladesh

Neurological manifestations of COVID-19 are being recognized day by day although predominant presentation is of respiratory illness. Understanding of impact of the virus on nervous system is important for selection and evolution of treatment now and in the future. The aim of the study was to describe the manifestations of COVID-19 affecting nervous system in a tertiary care hospital of Bangladesh.

GUILLAIN BARRÉ SYNDROME POST SARS-COV-2 INFECTION: A CASE REPORT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Guillain Barre Syndrome (GBS) is a syndrome usually consisting of paralyzing illness following an infectious process. SARS-COV-2 virus has well documented complications including pneumonia, ARDS, nephropathy, and thrombosis. Neurologic sequelae of GBS, as described in our case are much less common (1). CASE PRESENTATION: An 85-year-old African American male with recent COVID-19 infection, who presented to the emergency department with bilateral lower extremity weakness and bilateral upper extremity tingling for 24 hours. Vital signs were stable on admission. Physical exam revealed quadriparesis and sensory loss, areflexia of L4 and S1 and no saddle anesthesia. MRI brain and cervical spine revealed no signs of myelitis. Due to concern for COVID-19 post viral syndrome in the setting of new, rapidly progressing neurological symptoms, IVIG therapy was initiated. An EMG study was performed and was consistent with length dependent sensory and motor polyneuropathy, with mixed demyelinating and axonal features. Furthermore, there was minimal to absent recruitment of most muscles, consistent with high severity of disease. Patient's condition continued to worsen. He was intubated and placed on mechanical ventilatory support. While on mechanical ventilation, plasma exchange (PLEX) was initiated with subsequent improvement of his symptoms. Eventually, he was transferred to acute inpatient rehab to continue recovery. DISCUSSION: The most common peripheral nervous system manifestations of COVID-19 usually involve anosmia and chemosensory dysfunction (2). Case reports have shown an association between COVID-19 and GBS. It remains unclear whether humoral molecular mimicry, as seen in C. Jejuni, is also the driving mechanism behind the pathogenesis of GBS in SARS-CoV-2 (3). Reports have highlighted that no known SARS-CoV-2 epitopes have been found to be homologically similar to human peripheral nerve tissue and therefore unable to support immune driven, previously widely described molecular mechanisms of GBS (4). However, this lack of clear genetic similarity does not exclude immune mediated response as it's possible that immunogenic proteins could be modified post-translationally or have non-linear antibody epitopes driving such response (5). In addition, although there has been no evidence of SARS-CoV-2 detection in CSF (6), a small sample size of CSF studies from COVID 19 patients likely points towards overall inflammation caused by virus leading to immune cascade and possible infiltration of immune cells locally leading to CNS injury (7). CONCLUSIONS: Clinicians treating COVID-19 viral syndromes should be aware of the association between COVID-19 and GBS, especially when caring for patients with rapidly progressing neurologic disease. Further work needs to be done to broaden the understanding of pathogenesis of GBS in such cases. REFERENCE #1: Montalvan V, Lee J, Bueso T et al. Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clinical Neurology and Neurosurgery 194. REFERENCE #2: Lechner M, Chandrasekharan D, Jumani K, Liu et al. Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers - A systematic review of the literature, case series, and recommendations for clinical assessment and management. Rhinology. 2020 Aug 1;58(4):394-399. REFERENCE #3: Loshaj-Shala A, Regazzoni L, Daci A, Orioli M, Brezovska K, Panovska AP, et al. Guillain Barre syndrome (GBS): new insights in the molecular mimicry between C. Jejuni and human peripheral nerve (HPN) proteins. J Neuroimmunology 2015;289: 168–76. DISCLOSURES: No relevant relationships by Mateusz Gorecki, source=Web Response no disclosure on file for Dean Kalam;No relevant relationships by Ahamed Khalyfa, source=Web Response

A case of neuromyelitis optica spectrum disorder (NMOSD) and acute myositis following SARS-CoV-2 infection

Background and aims: Neurological manifestations of COVID-19 have been described. We report a case of seropositive NMOSD and acute myositis following SARS-CoV-2 infection. Methods: A previous healthy 35-years old man was admitted for NORB, a month after paucisymptomatic SARS-CoV-2 infection. Nasopharyngeal tests for SARS-CoV-2 was negative and serological IgG and IgM were positive. The neurological examination showed left eye blindness and myalgia. Blood examination showed elevated CK (>1000 UI/l), positive ANA (1:640) and anti-TPO (>1300 U/ml). Brain MRI showed T2/FLAIR left optic nerve hyperintensity with contrast enhancement. The EMG revealed signs of acute myogenic damage. He received intravenous methylprednisolone with poor recovery on vison but full recovery on muscle symptoms. Four months later he present NORB in contralateral eye;MRI showed optic chiasm hyperintensity, serum anti-AQP-4-antibodies were positive, EMG and CK were normalized. The patient received intravenous steroids and Immunoglobulins and started rituximab. Nevertheless, three months later he developed the area postrema syndrome, he was retreated with intravenous steroids and immunoglobulins and achieved a complete recovery. In March 2021, he underwent the second course of rituximab with clinical and radiological stability. Results: The patient was diagnosed with seropositive NMOSD, presented with recurrent NORB and area postrema syndrome, associated to acute myositis and autoimmune tiroiditis after SARS-CoV-2 infection. Conclusions: We supposed that SARS-CoV-2 may cause a post-infectious autoimmune response directed against AQP4 and other target (the muscle, the tiroid gland). Post-infectious autoimmunity is a potential mechanism in a subset of patients with COVID-19-related neurologic disease. Further research is needed to clarify this association.

Neurological Manifestations of COVID-19

Neurological Manifestations of COVID-19

Role of Neuroimaging in COVID 19 Infection—A Retrospective Study

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the family of coronaviruses, induces COVID-19 disease which is predominantly a respiratory illness. Several authors have reported neurological manifestations such as acute venous and arterial strokes and rarely acute disseminated encephalomyelitis, hemorrhagic posterior reversible encephalopathy syndrome, and acute inflammatory demyelinating polyneuropathy by studying magnetic resonance imaging of brain parenchymal signal abnormalities in patients with COVID-19. Owing to sparsity of literature on extrapulmonary manifestation of COVID, it is imperative to study the mechanism of neuronal invasion and manifestations of COVID-19. This study aimed to assess and correlate neurological manifestations in patients with COVID using imaging findings on computed tomography and magnetic resonance images. A retrospective observational study was conducted among 80 patients who tested positive for COVID-19 disease via a reverse transcription–polymerase chain reaction (RT-PCR) test in a tertiary care teaching institute in Pimpri, India. Most patients presented with acute arterial and venous strokes. Arterial stroke was the most prevalent finding; nearly 42.50% showed imaging findings consistent with arterial stroke; 25% patients had findings of venous stroke. Meningitis and spontaneous hemorrhage were found in 10% of cases. Rare complications such as acute disseminated encephalomyelitis comprised 7.50%, and encephalitis was found in 5%. This study highlights the need for increased neuroimaging in suspected patients to alert the treating physicians about the neurological complications. As the conventional RT-PCR and serum tests are unremarkable in the early onset of COVID-19, it is important to have a multidisciplinary approach and more neurology consultations in COVID-19 suspected patients with an emphasis on prompt neuroimaging to prevent potential life-threatening complications. To alert the attending physician about neurological involvement in patients with COVID-19, it is vital that nursing staff is aware about the neurological manifestations of COVID-19 so that they can recognize change in patients' neurological status without any undue time delay.

Neurological manifestations of COVID-19 in patients: from path physiology to therapy.

Coronavirus is a family of ARN positive single-stranded belonging to the family of Coronaviridae. There are several families of coronavirus that transmit more or less serious diseases. However, the so-called coronavirus-19 (SARS-CoV2) is the one that is currently causing most of the problems; in fact, biological dysfunctions that this virus causes provoke damage in various organs, from the lung to the heart, the kidney, the circulatory system, and even the brain. The neurological manifestations caused by viral infection, as well as the hypercoagulopathy and systemic inflammation, have been reported in several studies. In this review, we update the neurological mechanisms by which coronavirus-19 causes neurological manifestation in patients such as encephalomyelitis, Guillain-Barré syndrome, lacunars infarcts, neuropsychiatry disorders such as anxiety and depression, and vascular alterations. This review explains (a) the possible pathways by which coronavirus-19 can induce the different neurological manifestations, (b) the strategies used by the virus to cross the barrier system, (c) how the immune system responds to the infection, and (d) the treatment than can be administered to the COVID-19 patients.

Acute cerebellitis following SARS‐CoV‐2 infection: A case report and review of the literature

Novel coronavirus disease (COVID‐19) first described in Wuhan, China in December 2019, has rapidly spread across the world and become a global public health emergency. Literature on the neurological manifestations of COVID‐19 is limited. We report a 24‐year‐old male, who presented with vertigo, dysarthria, and bradyphrenia 3 weeks after being diagnosed with COVID‐19 on nasopharyngeal reverse transcription polymerase chain reaction. The patient was diagnosed with acute cerebellitis based on magnetic resonance imaging features and showed improvement posttreatment with intravenous methylprednisone for 5 days. The scope of this article is to highlight the importance of early identification of neurological symptoms and timely management as the outcomes may be catastrophic.

Neurologic Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

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.

Abstract 703: An inflammatory leptomeningeal signature in cancer patients with neurologic manifestations of COVID-19

Abstract Background: COVID-19 is associated with a wide spectrum of neurologic manifestations, which can emerge weeks to months after the initial infection. Cancer patients are at a heightened risk of severe infections due to their immunocompromised status. Leading hypotheses predict that SARS-CoV-2 neuroinvasion or neurologic toxicity from the systemic cytokine storm may account for neurologic dysfunction. Methods: We prospectively evaluated cancer patients with confirmed SARS-CoV-2 infection and subsequent neurologic manifestations at an NCI-designated cancer center. Evaluations included neurologic examinations, brain imaging, electroencephalogram, and cerebrospinal fluid (CSF) analysis for SARS-CoV-2 detection by RT-PCR for viral RNA and ELISA for nucleocapsid (N) and spike (S2) proteins. Additional proteomic analysis compared the CSF of patients with COVID-19 (CoV+) to cancer- and brain metastasis-matched COVID-19-negative controls (CoV-), and to patients with other cancer-associated neuroinflammatory conditions, including immune effector cell-associated neurotoxicity syndrome (ICANS) and autoimmune encephalitis. Results: Between May and July 2020, we evaluated 18 COVID-19-positive cancer patients with a wide range of solid tumor and hematologic malignancies. Thirteen (72.2%) of our patients received tumor-directed treatment within 30 days of SARS-CoV-2 infection. Neurologic diagnoses include protracted critical care delirium (N=10), limbic encephalitis (N=4), refractory headaches (N=2), rhombencephalitis (N=1), and large-territory infarctions (N=1). A median delay of 19 days (range 0-77) existed between onset of respiratory symptoms and neurologic manifestations. Among 13 patients who underwent CSF analysis, there was no evidence of SARS-CoV-2 neuroinvasion by RT-PCR in the CSF (N=13) or by N and S2 protein detection (N=10). Targeted proteomic analysis detected a significant accumulation of IL-6 and -8, IFN-gamma, CXCL-1, -6, -9, -10, and -11, CCL-8 and -20, MMP-10 and 4E-BP1 in the CSF of CoV+ patients (N=10) relative to matched CoV- controls (pooled, p=0.029). Combined analysis of these 12 inflammatory mediators revealed CoV+ cytokine levels approaching that of ICANS. CSF MMP-10, a marker of neurodegeneration, correlated with neurologic dysfunction by Karnofsky performance status (p=0.011) and by disability rating scale (p=0.086) at the time of lumbar puncture. Conclusion: A durable accumulation of IFN-gamma-mediated cytokines is detected in the CSF of cancer patients with neurologic manifestations of COVID-19, in the absence of detectable neuroinvasion. We hypothesize that cytokine-mediated neuroinflammation is responsible for the prolonged neurologic sequela of COVID-19. Our findings suggest a potential role for anti-inflammatory treatments in the management of such patients. Citation Format: Jessica A. Wilcox, Jan Remsik, N. Esther Babady, Tracy A. McMillen, Behroze A. Vachha, Neil A. Halpern, Vikram Dhawan, Marc Rosenblum, Christine A. Iacobuzio-Donahue, Edward K. Avila, Bianca Santomasso, Adrienne Boire. An inflammatory leptomeningeal signature in cancer patients with neurologic manifestations of COVID-19 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 703.

A SEVERE CASE OF COVID-19 THAT DEVELOPED ENCEPHALITIS AND TREATED SUCCESFULLY WITH IV IMMUNOGLOBULINS

Neurologic manifestations of COVID-19 have attracted widespread attention. Though the respiratory system is the primary target of SARS-CoV2, it is now increasingly recognised as a neuropathogen. Clinical features range from mild lethargy to deep coma and evidence of focal or diffuse neurologic signs and symptoms. The majority of patients with encephalitis are in critical condition. We report here a case of COVID-19-related encephalitis who developed persistent drowsiness 11 days after admission. The patient recovered well upon treatment with intravenous immunoglobulins (IVIg).

Neurological Manifestation of COVID-19: An Observational Study

Introduction: Covid-19 associated neurological syndromes has been recognized as an important part of the clinical spectrum of illness with a significant impact on mortality and morbidity. The common neurological manifestations are headache, dizziness, smell and taste disorders, encephalopathy, meningoencephalitis, acute cardiovascular syndromes, seizures, and peripheral nervous system disorders.Methodology: A single center retrospective study was undertaken to identify the presence/absence of neurological symptoms and signs in a sample of 1700 consecutive patients admitted with covid-19. A detailed questionnaire addressing comorbidities, admission details and clinical features was employed to collect data from the hospital records of patients with neurological signs and symptoms. The data was analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 22 software for relative frequency of various neurological syndromes and related variable.Results: 1700 COVID-19 patient records were analyzed of whom 230 of them showing one or more neurological manifestations. Among the COVID-19 patients with neurological manifestations, mean (standard deviation) age was 43 (19.8) years and half of them were (49.6%) male. Most common neurological symptom was headache reported by 80.9% of patients followed by smell and taste disorders (STD) (26.5%), dizziness (23.5%), myalgia (19.1%), altered sensorium (15 %), strokes (13.04%) and seizures (12.6%). 10% of patients succumbed to the illness of whom 52.2% had suffered a stroke.Conclusion: Neurological manifestations of covid-19 are manifold but well defined and replicated consistently by previous studies and ours. Increasing awareness of this important facet will ensure better identification and effective treatment of these conditions.Funding Statement: None to declare.Declaration of Interests: None to declare.Ethics Approval Statement: This study was approved by Institutional Ethics Committee of Malabar Institute Of Medical Sciences Ltd. (MIMS).

COVID-19 and Stroke

Most patients with COVID-19 present with constitutional and respiratory symptoms and some with atypical gastrointestinal, cardiovascular, or neurological manifestations. Recent studies suggest that there are neurologic manifestations of COVID-19, including acute cerebrovascular disease (CVD). The aim of this study is to find out any evidence of COVID-19 related stroke. Radiologic studies of the patients admitted to the emergency department (ED) of our center from March 11 Th to June 10 Th 2020, with acute stroke symptoms and of whom the acute cerebrovascular disease is confirmed by Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) are searched retrospectively. CT Angiography (CTA) and MR Angiography (MRA) studies obtained for stroke management, searched for acute thromboembolism. We noticed some radiologic evidence of acute cerebrovascular disease in 56 patients of 528 patients admitted with immediate neurological symptoms. 11 (19.64 %) of these patients who were not diagnosed before, proved to be simultaneous COVID-19 infection with laboratory tests and/or thorax CT. It was noteworthy that these 11 patients presented with an acute cerebrovascular event supported by neurological and radiological findings instead of the well-known constitutional or respiratory symptoms of COVID 19 infection. 45 (80.35 %) patients were negative for COVID-19 infection. CT /or MR Angiography demonstrated carotid or intracranial major arterial thromboembolism in 5 (11.1 %) of the non-COVID-19 patients and 5 (45.4 %) of the simultaneous COVID-19 disease diagnosed ones. COVID19 positive 5 patients presented with acute internal carotid artery (ICA) or major ICA branch thrombosis at the first stage of COVID-19 infection, rather than a complication of the serious lung disease or a component of multiorgan disfunction related COVID-19. Acute cerebrovascular disease symptoms bringing patients to the ED instead of the respiratory symptoms, aroused high suspicion of the direct neuropathy and early coagulopathy effect of the virus. COVID- 19 disease, itself thought to be a great risk factor for stroke alone. Even in initial cases and in cases where COVID-19 infection do not show a severe and fatal course, stimulation in the coagulation cascade in the early stages, increased the risk of acute stroke.

SOME ASPECTS OF ETHIOPATHOGENESIS OF NEUROLOGICAL MANIFESTATIONS IN CORONAVIRUS INFECTION AND STUDY OF THE EXPRESSION AND PREVALENCE OF SMELLAND TASTE IMPAIRMENTS IN PATIENTS WITH SARS-COV-2

The new coronavirus SARS-CoV-2 and the disease it causes, COVID-19, along with damage to the respiratory system, sometimes leads to nervous system disorders. The loss of smell and taste in COVID-19 is most likely of a perceptual nature. Because of the active accumulation of information about the symptomatology of this nosology, data appeared on the characteristic manifestations of thedisease in mild and moderate cases, in particular, on the violation of taste and smell. Although there is currently insufficient data to determine the exact mechanisms of anosmia and ageusia in patients diagnosed with COVID-19, there are studies that support certain theories. This paper presents the results of a systematic database review of COVID-19 taste and smell disorders. The article analyzes information on the etiopathogenic aspects of the neurological manifestations of COVID-19 and data on the severity and prevalence of smell and taste disorders in patients with coronavirus.Keywords: COVID-19, SARS-CoV-2, novel coronavirus infection, loss of smell and taste, anosmia, hypogeusia, ACE2 receptors

Neurological Manifestations of COVID-19 (4987)

Neurological Manifestations of COVID-19 (4987)

Neurologic manifestations of COVID-19 in a Diverse Population in Chicago, Illinois (121)

Neurologic manifestations of COVID-19 in a Diverse Population in Chicago, Illinois (121)

Curious case of steroid responsive diffuse anterior horn cell disease associated with COVID-19 infection.

Covid-19-associated neurological manifestations are being reported with increased frequency throughout the world. In a study from China, symptoms referable to peripheral nervous system (PNS) were described in approximately 9% of hospitalized Covid-19 patients. Common PNS symptoms reported in the study were loss of taste/smell and muscle pains. With this communication, we expand the spectrum of PNS manifestations of Covid-19 infection by reporting an association of steroid responsive diffuse anterior horn cell disease with Covid-19 infection from a tertiary care centre in India. Neurological manifestations of Covid-19 are diverse, and our case which to best of my knowledge is the first case in literature to report an occurrence of steroid responsive diffuse anterior horn cell disease associated with Covid-19 infection, adds to the ever-increasing spectrum of neurological manifestations associated with this pandemic causing virus. Good response to steroid in our case serves to provide an insight into the possible pathogenesis of this manifestation and also paves the way for future therapeutic decisions related to this association.

Reader Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.

Frontera et al.1 should be commended on the breadth of their report on neurologic diagnoses in COVID-19. Although stroke, seizure, GBS, encephalitis, and meningitis rates are similar to our recent study,2 and others,3,4 their rates of encephalopathy were markedly lower (6.9% vs 31.8%).1,2 This likely reflects their methodology of adjudicating diagnoses only from chart review of patients with neurologic consultation. Our study similarly included patients with confirmed SARs-CoV-2 RT PCR and ascribed diagnoses by neurologist adjudication. We recognized that delirium—an entity within the encephalopathy spectrum—is the purview of multiple specialties.5 As such, encephalopathy would not reliably result in neurologic consultation; we adjudicated all charts and leveraged protocolized delirium assessments. The methodology of Frontera et al. likely failed to identify many encephalopathic patients, limiting their estimation of neurologic morbidity. Nevertheless, encephalopathy remained the most frequent neurologic diagnosis. In addition, prematurely excluding headache as a “neurologic symptom” limits the scope and understanding of SARS-CoV-2 neuropathogenesis. As we determine optimal management and decipher the long-term consequences of COVID-19 and encephalopathy, study methodologies should consider that not all neurologic complications result in in-hospital neurologic consultation. Consistently, neurologic manifestations of COVID-19 are common and encephalopathy impacts morbidity. Interestingly, despite similar ventilation rates (26.3% vs 22.0%), our cohort's hospital mortality was considerably lower (8.4% vs 21.4%).1,2 Although New York experienced a critical strain on hospital infrastructure early in the pandemic, our Chicago area hospital system never experienced the same overwhelming case surge. Taken together, Frontera et al. and our study may reflect the magnitude of public health benefit that could be realized by avoiding case volumes that overwhelm health care infrastructure. This should further emphasize the benefit of universal masking, social distancing, and building redundancy into health care infrastructure.

Coronavirus Disease (COVID-19)-Related Disseminated Leukoencephalopathy: A Retrospective Study of Findings on Brain MRI.

Among 2820 inpatients with coronavirus disease (COVID-19), 59 (2.1%) underwent brain MRI. Of them, six (10.2%) had MRI findings suspicious for COVID-19-related disseminated leukoencephalopathy (CRDL), which is characterized by extensive confluent or multifocal white matter lesions (with characteristics and locations atypical for other causes), microhemorrhages, diffusion restriction, and enhancement. CRDL is an uncommon but important differential consideration in patients with neurologic manifestations of COVID-19.

Neurological Manifestations of COVID-19: A Series of Seven Cases.

Goel K, Kumar A, Diwan S, Kohli S, Sachdeva HC, Usha G, et al. Neurological Manifestations of COVID-19: A Series of Seven Cases. Indian J Crit Care Med 2021;25(2):219-223.