Neurological Manifestations Of COVID-19 Research Articles

Neurological manifestations of COVID-19: an investigation into the role of viral neurotropism

Introdução. A pandemia da COVID-19 desencadeou uma crise sanitária com mais de 700 milhões de infectados e 7 milhões de óbitos. Hoje, compreende-se que os impactos da pandemia ultrapassam o sistema respiratório, abrangendo uma diversidade de manifestações clínicas sistêmicas, incluindo o sistema nervoso. Objetivo. Realizar uma revisão científica de literatura com o intuito de elucidar a capacidade de infecção neurológica do SARS-CoV-2 bem como avaliar as manifestações neurológicas provocadas pela COVID-19. Método. Revisão de literatura de caráter integrativo com estudos publicados entre 2020 e 2023 obtidos nas plataformas Pubmed e Elsevier. Foram empregados os seguintes descritores: SARS-CoV-2, COVID-19, sistema nervoso, manifestações neurológicas e neurotropismo. Resultados. As principais manifestações obtidas, foram no sistema nervoso central: cefaleia, encefalopatia, encefalite e acidente vascular cerebral (AVC). Sistema nervoso periférico: anosmia, ageusia, disgeusia, síndrome de Guillain-Barré (SGB) e hiposmia. Destaca-se também sintomas neuropsicológicos que foram desenvolvidos após infecção: irritabilidade, ansiedade, distúrbios do sono, instabilidade emocional, baixo ânimo, perda de memória e depressão, bem como sintomas de confusão, vertigem, zumbido no ouvido e queda de cabelo. Além dos persistentes mesmo após cura da infecção: anosmia/ageusia, cefaleia, mialgia, encefalopatia, encefalite, AVC, SGB, paralisia de nervos cranianos, ataxia cerebelar aguda e mioclonia. Conclusão. A pesquisa das manifestações neurológicas torna-se crucial para o entendimento da complexidade das interações do vírus e o sistema nervoso, assim como a contínua investigação do neurotropismo viral, que transcende a COVID-19 e nos leva um futuro mais informado e preparado para enfrentar desafios emergentes de saúde pública.

Complexity and Diversity of the Neurological Spectrum of SARS-CoV-2 over Three Waves of COVID-19.

Background/Objectives: SARS-CoV-2 continually mutates, with five identified variants. Many neurological manifestations were observed during the COVID-19 pandemic, with differences between virus variants. The aim of this study is to assess the frequency and characteristics of neurological manifestations during COVID-19 in hospitalized patients over three waves in Poland with comparison and analysis correlation with the course of infection. Methods: This retrospective single-center study included 600 consecutive adults with confirmed COVID-19, hospitalized during 3 waves (pre-Delta, Delta and Omicron) in Poland. Demographic and clinical information and neurological manifestations were collected and compared across three periods. Results: The median age of the study group was 68, lower during the Delta wave. In the Omicron period, the disease severity at admission and inflammatory markers concentration were the lowest. Neurological manifestations were observed in 49%. The most common were altered mentation, headache, myalgia, mood disorder, ischemic stroke and encephalopathy. Smell and taste disturbances (STDs) were less frequent in the Omicron period. Neurological complications were predominant in the pre-Delta and Omicron periods. Ischemic stroke was observed more often in pre-Delta period. Altered mentation was related to higher severity at admission, worse lab test results, higher admission to ICU and mortality, while headache reduced mortality. Pre-existing dementia was related to higher mortality. Conclusions: Neurological manifestations of COVID-19 are frequent, with a lower rate of STDs in the Omicron period and more often cerebrovascular diseases in the pre-Delta period. Headache improves the course of COVID-19, while altered mentation, stroke and neurological comorbidities increase severity and mortality.

The Neurological Manifestations of COVID-19: Meta-analysis of the Most Extensive Review of Published Case Reports (P11-13.008)

The Neurological Manifestations of COVID-19: Meta-analysis of the Most Extensive Review of Published Case Reports (P11-13.008)

FDG PET in Neurological Manifestations of COVID-19.

Both the central and peripheral nervous systems can be affected in COVID-19. Although MRI is the primary investigative tool for neurological imaging, FDG PET may show additional areas of involvement in the brain in the form of regional hypometabolism or hypermetabolism, secondary to synaptic dysfunction and electrical or glial activation. We present a case series of 4 patients who had neurological symptoms attributable to COVID-19 infection with abnormalities in the brain FDG PET scan.

Clinical Manifestations of COVID-19 in Different Periods of the Pandemic in Persons from Occupational Risk Groups of Infection

Relevance. One of the most affected by the new coronavirus infection (COVID-19) groups of the population were medical workers who have high risks of infection in the performance of professional dutiesAim. Analysis the clinical manifestations of COVID–19 in different periods of the pandemic in medical organizations, taking into account the genetic variability of circulating strains of SARSCoV- 2 and vaccination status.Materials and methods. To study the clinical manifestations of coronavirus infection, an online survey of medical workers in a large industrial region was conducted in March 2022 using a specially designed anonymous questionnaire. The total number of respondents was 3,078. Clinical manifestations were analyzed during five epidemic rises in the incidence of COVID-19 from March 2020 to March 2022. To assess the SARS-CoV-2 virus strains circulating in the region, data from the GISAID database (the first and second waves of the pandemic, n = 298) and the results of PCR studies in the laboratory of UMMC-Health LLC (third - fifth waves, n = 349) were used.Results and discussion. In the first and second epidemic rises of morbidity associated with SARS-CoV-2 strains B.1. and B.1.1, the structure of clinical forms did not significantly differ: 3.6% and 3.9% were asymptomatic forms, 61.3% – variants of acute respiratory infection (AR I) and 35.1% and 34.8% - pneumonia, accordingly. In the third epidemic upsurge caused by the Delta variant (V.1.617.2), the structure of clinical forms did not undergo significant changes. In the fourth epidemic rise in morbidity, also associated with the spread of the Delta variant, the share of ARI in the structure of clinical forms increased to 77.0%, and pneumonia decreased to 21.3%.In the fifth wave of the pandemic caused by the Omicron gene variant (B.1.1.529), there was an increase to 91.3% of the proportion of mild clinical forms and a decrease to 7.1% of forms with lung damage. The frequency of detection of general infectious symptoms, upper respiratory tract lesions and neurological manifestations of COVID-19 had statistically significant differences in different periods of the pandemic. Whereas the frequency of gastrointestinal disorders did not significantly differ. The high clinical efficacy of vaccination has been shown – in ter ms of a 3.6-fold reduction in the chances of developing moderate and severe forms of the disease.Conclusion. Based on the results of the study, new data were obtained on the features of the clinical manifestations of COVID-19 in different periods of the pandemic with the change of genetic variants of the pathogen and the role of vaccination in preventing the development of moderate and severe clinical forms of infection was shown.

Neurological manifestations of COVID-19 among patients admitted at a tertiary care hospital in Islamabad ICT, Pakistan 2021

Neurological manifestations of COVID-19 among patients admitted at a tertiary care hospital in Islamabad ICT, Pakistan 2021

Sex differences in neurologic presentation and outcome of SARS-CoV-2, especially cerebrovascular manifestations

Neurological manifestations of COVID-19 and their impact have not been well characterized. Neurological involvement may be caused directly by the effects of the virus infecting the brain or indirectly by the local and systemic immune responses against the virus. Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The arrival of COVID-19 represented a unique occasion to study sex difference, and accentuated the need for further study to elucidate the mechanisms that differentiate clinical outcomes among male and female patients. Recent pandemics has a clear sex disparity in clinical outcomes, and morbidity and mortality from COVID-19 are higher among men. Interestingly, the previous decade, there was sparse literature evaluating the impact of sex differences on outcomes in infectious diseases, especially on neurologic complications. Ongoing advances in scientific research have demonstrated sex differences in the neurological complications of neuroinfectious diseases, and sex and disparities in health care are frequently encountered. The evidence for potential sex differences and gender inequalities, including socioeconomic status and occupational exposure in the COVID-19 pandemic is continuing to emerge. In summary, sex is increasingly recognized as a critical determinant of health and disease, particularly relevant to the topical COVID-19 pandemic. Morbidity and mortality from COVID-19 are greater for males, however, the mechanisms for this difference are unclear. Understanding the differences in outcomes between males and females improve the effectiveness of health interventions. However, outcomes of the neurologic complications of infectious disease may be partially explained by sex differences in immune responses. With this narrative, we intend to provide the reader with a comprehensive coverage of where we currently stand regarding sex differences specific, especially on outcomes critical neurologic manifestations of the SARS-CoV-2 infection.

Retraction Statement: Neurological manifestations of COVID-19: A potential gate to the determinants of a poor prognosis.

Retraction Statement: Neurological manifestations of COVID-19: A potential gate to the determinants of a poor prognosis.

Mortality and Outcomes in Cerebrovascular Disease Patients With Emphasis on COVID-19: A Cross-Sectional Analysis of the National Inpatient Sample 2020.

Background COVID-19-related pulmonary complications have been explored extensively in the recent past. There is also a significant amount of literature on the neurological manifestations of COVID-19. However, there exists an unmet need to assess the impact of COVID-19 on patients with cerebrovascular diseases and its role in affecting mortality in such patients. Methods In this cross-sectional study, we analyzed 401,318 hospitalized patients with cerebrovascular diseases using the discharge data from the National Inpatient Sample 2020 to assess the association of COVID-19 with multiple clinical conditions, along with additional factors, such as length of stay in the hospital, total charges incurred, region and type of hospital, and primary insurance/payer in the United States of America. We used a multivariable logistic regression model to predict factors relating to mortality in such patients. Results The mortality during hospitalization in patients with cerebrovascular disease who were also diagnosed with COVID-19 was significantly higher than the patients without COVID-19 (22.50% vs 5.44%, p-value <0.0001). COVID-19 independently increased the odds of death significantly in patients with cerebrovascular diseases (adjusted OR = 4.81, p-value <0.0001). Other statistically and clinically significant factors that contributed to increased odds of mortality in such patients were comorbidities such as moderate/severe liver disease, myocardial infarction, congestive heart failure, and complications such as the development of a saddle pulmonary embolus. Conclusion COVID-19 was associated with higher mortality in patients with cerebrovascular diseases. It also significantly increased the duration of hospital stay and odds of mortality in such patients.

Neurological manifestations of COVID-19 in pregnancy: a cross-sectional study.

The occurrence of neurological manifestations and complications in pregnant women compared to non-pregnant women with COVID-19 is unclear. This cross-sectional study included women aged over 18years hospitalized with SARS-CoV-2 infection confirmed by RT-PCR from March to June 2020 in Recife, Brazil. We evaluated 360 women, including 82 pregnant patients who were significantly younger (27.5 vs. 53.6years; p < 0.01) and less frequently obese (2.4% vs. 15.1%; p < 0.01) than the non-pregnant group. All pregnancies were confirmed using ultrasound imaging. Abdominal pain was the only more frequent COVID-19 manifestation during pregnancy (23.2% vs. 6.8%; p < 0.01), but was not associated with the outcomes. Almost half the pregnant women presented neurological manifestations, including anosmia (31.7%), headache (25.6%), ageusia (17.1%), and fatigue (12.2%). However, neurological manifestations occurred similarly in pregnant and non-pregnant women. Four (4.9%) pregnant women and 64 non-pregnant women (23%) presented delirium, but the frequency with age-adjustment was similar in the non-pregnant group. Pregnant women with COVID and preeclampsia (19.5%) or eclampsia (3.7%) were older (31.8 vs. 26.5years; p < 0.01), and epileptic seizures occurred more often in association with eclampsia (18.8% vs. 1.5%; p < 0.01) regardless of previous epilepsy. There were three maternal deaths (3.7%), one dead fetus, and one miscarriage. The overall prognosis was good. There was no difference in prolonged hospital stay, the need for ICU and mechanical ventilation, or death when comparing pregnant and non-pregnant women.

Pediatric Neuroinflammatory Disease in the Era of COVID-19: Single Center Survey of the Medical and Social Impact of COVID-19 and COVID-19 Vaccines (S34.006)

<h3>Objective:</h3> We explore the impact of COVID-19 in pediatric patients with neuroinflammatory disorders and describe parent/guardian vaccination concerns and self-reported side effects of the COVID-19 vaccination. <h3>Background:</h3> Neurological manifestations of COVID-19 in children range from mild to severe. There is limited data surrounding COVID-19 and the COVID-19 vaccine in pediatric populations with known neuroinflammatory disorders. <h3>Design/Methods:</h3> A survey was distributed to guardians of 68 children enrolled in a single center neuroimmunology registry. Clinical data was obtained from the registry. <h3>Results:</h3> 26 (38%) responded to the survey (62% female). Diagnoses included multiple sclerosis (5, 19%), myelin oligodendrocyte glycoprotein antibody-associated disease (8, 31%), acute disseminated encephalomyelitis (1, 4%), autoimmune encephalitis (1, 14%), and other (16, 57%). 10 (38%) had a confirmed COVID-19 diagnosis, and 3 were classified as probable COVID-19 cases based on CDC clinical and exposure criteria. Neurological symptoms in the 6-weeks after confirmed or probable COVID-19 infections were: behavioral changes (4, 31%), paresthesias (1, 8%), taste changes (3, 23%) vision changes (2, 15%) urinary retention (1, 8%), and gait abnormalities (1, 8%). 12 (46%) received at least one COVID-19 vaccine dose. For unvaccinated children, 50% of respondents were “not at all willing” to vaccinate and lack of knowledge of long-term side effects was the most common reason. Neurological side effects in the 6-weeks following the vaccination included: behavioral changes (2, 17%), parasthesias (1, 8%), and gait abnormalities (1, 8%). Of children with confirmed or probable COVID-19 or who received a COVID-19 vaccine, none experienced neurological disease flares requiring treatment alterations or hospitalization. <h3>Conclusions:</h3> Half of children with a neuroinflammatory disease had confirmed or probable COVID-19 and less than half were vaccinated against COVID-19. Children with COVID-19 or who received the COVID-19 vaccine did not have disease flares requiring change in immunotherapy or hospitalization. Guardians are concerned about long term side effects of COVID-19 vaccines. <b>Disclosure:</b> Ms. Bahri has nothing to disclose. Ms. Hurst has nothing to disclose. Ms. Alexander has nothing to disclose. Dr. Hutchinson has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Katz, Korin, Cunningham Attorneys At Law.

Headaches associated with COVID-19

Headache is a common symptom of both the acute and post-COVID-19 periods which often persists for a long time. Headache is the leading symptom among all the neurological manifestations of COVID-19, and it also can be a severe deconditioning disorder in about one fifth of patients. A new type of headache may occur or an existing primary cephalal gia pattern may worsen in a patient with COVID-19. During the acute period of infection, cephalgia in most patients can be considered as a headache associated with acute viral infections. However, other forms such as a cough headache, exertional headache, etc. are often considered. In these cases, cephalgic manifestations correlate with other COVID-19 symptoms. The long-term persistent headaches, as one of the most frequent and persistent symptoms of the post-COVID syndrome, often occur according to the type of tension headaches and migraines and are significantly more often detect ed in people with a prior history of cephalalgia. The diversity of headache phenotypes in COVID-19 requires the involve ment of universal strategies for their management. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most widely investigated and commonly used to relieve pain in clinical practice, as well as fever and other symptoms of infection. The long-term experience with the use of NSAIDs in clinical practice, the availability of clinical data and the results of special studies reveal the possibility of their usage in patients with COVID-19 and complaints of headaches. However, a thorough analysis of current records of their use in patients with COVID-19 is required for the effective and safe use of NSAIDs in this category of patients.

Neurologic manifestations and COVID-19

In the article by Jiménez-Ruiz et al., entitled “Neuro-logic manifestations of COVID-19”,1 it was concluded that “we must bear in mind infectious and non-infec-tious complications that affect the nervous system such as encephalitis, seizures, Guillain-Barre syndrome, dis-seminated encephalomyelitis and hemorrhagic leuko-encephalitis, which are disorders that can occur during or after viral infections.

COVID-19 Associated Neurological Manifestation.

At the end of 2019, COVID-19 was first detected in Wuhan. In March 2020, COVID-19 became a pandemic globally. Saudi Arabia registered the first case of COVID-19 on March 2, 2020. This research aimed to identify the prevalence of different neurological manifestations of COVID-19 and to assess the relation of the severity, vaccination state, and continuity of symptoms to the occurrence of these symptoms. Cross-sectional retrospective study was done in Saudi Arabia. The study was conducted on previously diagnosed COVID-19 patients by random selection using a predesigned online questionnaire to collect data. Data was entered through Excel and analyzed through SPSS version 23. The study showed that the most common neurological manifestations in COVID-19 patients are headache (75.8%), changes in sense of smell and taste (74.1%), muscle pain (66.2%), and mood disturbance (depression, anxiety) (49.7%). Whereas other neurological manifestations such as weakness of the limbs, loss of consciousness, seizure, confusion, and vision changes are significantly associated with older individuals, this may lead to increased mortality and morbidity in these patients. COVID-19 is associated with many neurological manifestations in the population of Saudi Arabia. The prevalence of neurological manifestations is similar to many previous studies, where acute neurological manifestations such as loss of consciousness and convulsions are seen more in older individuals which may lead to increased mortality and worse outcomes. Other self-limited symptoms such as headache and change in smell function i.e., anosmia or hyposmia were more pronounced in those <40 years. This mandates more attention to elderly patients with COVID-19, to early detect common neurological manifestations associated with it, and to apply preventive measures known to improve the outcome of these symptoms.

Genetic Predisposition to Neurological Complications in Patients with COVID-19.

Several studies have identified rare and common genetic variants associated with severe COVID-19, but no study has reported genetic determinants as predisposition factors for neurological complications. In this report, we identified rare/unique structural variants (SVs) implicated in neurological functions in two individuals with neurological manifestations of COVID-19. This report highlights the possible genetic link to the neurological symptoms with COVID-19 and calls for a collective effort to study these cohorts for a possible genetic linkage.

Current approaches in the treatment and rehabilitation of patients with neurological diseases after COVID-19. Resolution of the International Experts Forum

Despite the significant shift in global attention away from the pandemic, the problem of a new coronavirus infection remains important in the medical community. Almost 3 years after the start of the COVID-19 pandemic the issues of rehabilitation and management of delayed manifestations and sequelae of the disease are especially important. According to numerous available data, the new coronavirus infection is characterized by multiorgan lesions. Respiratory dysfunction, clotting disorders, myocardial dysfunction and various arrhythmias, acute coronary syndrome, acute renal failure, GI disorders, hepatocellular damage, hyperglycemia and ketosis, dermatological complications, ophthalmological symptoms and neurological disorders may be found. Significant prevalence of the latter in the post-coronavirus period necessitated this International Expert Forum to develop unified approaches to the management of patients with neurological complications and sequelae of new coronavirus infection based on practical experience and considering the scientific information available on COVID-19. The expert council developed a resolution formulating the tactics for the management of patients with neurological manifestations of COVID-19.

Comparative features and outcomes of major neurological complications of COVID-19.

The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations. The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors. By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N=449, 29.5%), stroke (N=392, 25.7%), sleep-wake disturbances (N=250, 16.4%), dysautonomia (N=224, 14.7%), peripheral neuropathy (N=145, 9.5%), movement disorders (N=142, 9.3%), ataxia (N=134, 8.8%), and seizures (N=126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome. Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.

Integrated network-based multiple computational analyses for identification of co-expressed candidate genes associated with neurological manifestations of COVID-19

‘Tripartite network’ (TN) and ‘combined gene network’ (CGN) were constructed and their hub-bottleneck and driver nodes (44 genes) were evaluated as ‘target genes’ (TG) to identify 21 ‘candidate genes’ (CG) and their relationship with neurological manifestations of COVID-19. TN was developed using neurological symptoms of COVID-19 found in literature. Under query genes (TG of TN), co-expressed genes were identified using pair-wise mutual information to genes available in RNA-Seq autopsy data of frontal cortex of COVID-19 victims. CGN was constructed with genes selected from TN and co-expressed in COVID-19. TG and their connecting genes of respective networks underwent functional analyses through findings of their enrichment terms and pair-wise ‘semantic similarity scores’ (SSS). A new integrated ‘weighted harmonic mean score’ was formulated assimilating values of SSS and STRING-based ‘combined score’ of the selected TG-pairs, which provided CG-pairs with properties of CGs as co-expressed and ‘indispensable nodes’ in CGN. Finally, six pairs sharing seven ‘prevalent CGs’ (ADAM10, ADAM17, AKT1, CTNNB1, ESR1, PIK3CA, FGFR1) showed linkages with the phenotypes (a) directly under neurodegeneration, neurodevelopmental diseases, tumour/cancer and cellular signalling, and (b) indirectly through other CGs under behavioural/cognitive and motor dysfunctions. The pathophysiology of ‘prevalent CGs’ has been discussed to interpret neurological phenotypes of COVID-19.

Neurological manifestations of COVID-19 in a five-year-old child

A new coronavirus infection (COVID-19, Corona Virus Disease 2019) is a disease caused by the SARS-CoV-2 virus, presenting as both a mild acute respiratory viral infection and a severe form, with damage to various organs and systems. In children under 16 years of age infected with SARS-CoV-2, the vast majority of cases were mild, without marked neurological manifestations.This paper describes a case of acute disseminated encephalomyelitis in a five-year-old child associated with SARS-CoV-2, which caused difficulties in the differential diagnosis with demyelinating diseases and hereditary pathology. The disease was diagnosed in a family where both parentswere diagnosedwith COVID-19 by polymerase chain reaction (PCR).The CNSlesionwasrepresented by severe central hemiparesis, involvement of some cranial nerves, with impaired pelvic organ function. During the treatment there was a positive dynamicsin the somatic and neurologicalstatus. The patient was discharged for outpatient treatment with satisfactory rehabilitation potential.SARS-CoV-2 lesions of the nervous system in children can lead to life-threatening and fatal conditions. Timely diagnosis and a comprehensive approach to the management of a child with encephalomyelitis made it possible to avoid adverse effects of the disease and improve the rehabilitation prognosis.

New-Onset Non-convulsive Status Epilepticus in Previously Healthy COVID-19 Patient

The novel severe acute respiratory syndrome (SARS-CoV-2) virus has spread rapidly worldwide in the last several year. COVID-19 presentation ranges widely from asymptomatic to acute respiratory failure. Interestingly, although neurological manifestations of COVID-19 have often been described in the literature, only a few cases reports describe status epilepticus associated with COVID-19 patients.This is a case of a 52-year-old previously healthy woman who presented to the emergency department with fever, worsening cough, shortness of breath, and hypoxia. She was found to be COVID-19-positive. She developed a bilateral tonic-clonic seizure 16 days after her first symptoms appeared. Continuous video encephalogram (CEEG) showed a generalized periodic pattern with triphasic morphology. This finding is suggestive of non-convulsive status epilepticus which resolved after valproic acid loading as given. The patient is fully recovered at 6 months follow-up and seizure-free on levetiracetam 750 mg twice daily.This case demonstrates a new onset of bilateral tonic-clonic seizure followed by non-convulsive status epilepticus associated with COVID-19 infection. As the spectrum of COVID-19 neurological manifestation has yet to be established, healthcare providers should be cognizant of the possibility of non-convulsive status epilepticus in COVID-19 patients in order to provide timely workup and management.