Download PDF
CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2020; 56(04): 191-196
DOI: 10.1055/s-0040-1717833
Review Article

Neurological Problems in COVID-19 Pandemic

Shiv Kumar Saini
1   Department of Neurology, Dr Ram Manohar Lohia Hospital, New Delhi, India
,
Kuljeet Singh Anand
1   Department of Neurology, Dr Ram Manohar Lohia Hospital, New Delhi, India
,
Abhishek Juneja
1   Department of Neurology, Dr Ram Manohar Lohia Hospital, New Delhi, India
,
Rakesh Kumar Mahajan
2   Department of Microbiology, Dr Ram Manohar Lohia Hospital, New Delhi, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Coronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This outbreak, which emerged in Wuhan city, rapidly spread throughout China and has now become a global public health concern. SARS-CoV-2 is a highly pathogenic and transmissible virus. Common clinical manifestations of COVID-19 include fever, dry cough, shortness of breath, muscle ache, headache, and confusion. Currently, there is no confirmed effective therapeutic strategy for COVID-19 because the pathological mechanism is poorly understood. In addition to the respiratory system involvement, recent evidence has shown that SARS-CoV-2 can affect other organ systems including nervous, vascular, digestive, and urinary system. Various neurological complications have also been described in various studies. Nervous system involvement in the case of SARS-CoV-2 is explained by direct neuro invasion, immune mechanism, and other systemic factors. Neurological complications due to SARS-CoV-2 include both central and peripheral nervous system involvement. Central nervous system complications range from mild headache to seizures, encephalitis, myelitis, and acute cerebrovascular accidents. Peripheral nervous system complications range from vague muscle pains to Guillain–Barré syndrome. This article briefly discusses the various neurological and mental health issues related to COVID-19.

Keywords

neurological - pandemic - COVID-19


Publication History

Article published online:
23 September 2020

© 2020. National Academy of Medical Sciences (India). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 WHO Coronavirus disease. 2019 (COVID-19). Situation Report—41. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200521-covid-19-sitrep-122.pdf?sfvrsn=24f20e05_2.. Accessed March 3, 2020
  • 2 Pang J, Wang MX, Ang IYH. et al. Potential rapid diagnostics, vaccine and therapeutics for 2019 novel coronavirus (2019-nCoV): a systematic review. J Clin Med 2020; 9 (03) 623
    CrossrefPubMedGoogle Scholar
  • 3 Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal 2020; 10 (02) 102-108
    CrossrefPubMedGoogle Scholar
  • 4 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223) 507-513
    CrossrefPubMedGoogle Scholar
  • 5 Li Z, Liu T, Yang N. et al. Neurological manifestations of patients with COVID-19: potential routes of SARS-CoV-2 neuroinvasion from the periphery to the brain. Front Med 2020; DOI: 10.1007/s11684-020-0786-5.
    CrossrefPubMedGoogle Scholar
  • 6 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223) 497-506
    CrossrefPubMedGoogle Scholar
  • 7 Xu Z, Shi L, Wang Y. et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8 (04) 420-422
    CrossrefPubMedGoogle Scholar
  • 8 Yu F, Du L, Ojcius DM, Pan C, Jiang S. Measures for diagnosing and treating infections by a novel coronavirus responsible for a pneumonia outbreak originating in Wuhan, China. Microbes Infect 2020; 22 (02) 74-79
    CrossrefPubMedGoogle Scholar
  • 9 Song Z, Xu Y, Bao L. et al. From SARS to MERS, thrusting coronaviruses into the spotlight. Viruses 2019; 11 (01) 59
    CrossrefPubMedGoogle Scholar
  • 10 Lu R, Zhao X, Li J. et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395 (10224) 565-574
    CrossrefPubMedGoogle Scholar
  • 11 Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol 2020; 94 (07) e00127-e20
    CrossrefPubMedGoogle Scholar
  • 12 Yuan Y, Cao D, Zhang Y. et al. Cryo-EM structures of MERS-CoV and SARS-CoV spike glycoproteins reveal the dynamic receptor binding domains. Nat Commun 2017; 8: 15092
    CrossrefPubMedGoogle Scholar
  • 13 Hulswit RJ, de Haan CA, Bosch BJ. Coronavirus spike protein and tropism changes. Adv Virus Res 2016; 96: 29-57
    CrossrefPubMedGoogle Scholar
  • 14 Paybast S, Emami A, Koosha M, Baghalha F. Novel coronavirus disease (COVID-19) and central nervous system complications: what neurologist need to know. Acta Neurol Taiwan 2020; 29 (01) 24-31
    PubMedGoogle Scholar
  • 15 Lau KK, Yu WC, Chu CM, Lau ST, Sheng B, Yuen KY. Possible central nervous system infection by SARS coronavirus. Emerg Infect Dis 2004; 10 (02) 342-344
    CrossrefPubMedGoogle Scholar
  • 16 Zhao Y, Zhao Z, Wang Y. et al. Single-Cell RNA expression profiling of ACE2, the putative receptor of Wuhan 2019-nCoV. bioRxiv 2020; DOI: 10.1101/2020.01.26.919985.
    CrossrefGoogle Scholar
  • 17 Kuhn JH, Li W, Choe H, Farzan M. Angiotensin-converting enzyme 2: a functional receptor for SARS coronavirus. Cell Mol Life Sci 2004; 61 (21) 2738-2743
    CrossrefPubMedGoogle Scholar
  • 18 Qian Z, Travanty EA, Oko L. et al. Innate immune response of human alveolar type II cells infected with severe acute respiratory syndrome-coronavirus. Am J Respir Cell Mol Biol 2013; 48 (06) 742-748
    CrossrefPubMedGoogle Scholar
  • 19 Lu G, Hu Y, Wang Q. et al. Molecular basis of binding between novel human coronavirus MERS-CoV and its receptor CD26. Nature 2013; 500 (7461) 227-231
    CrossrefPubMedGoogle Scholar
  • 20 Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci 2020; 11 (07) 995-998
    CrossrefPubMedGoogle Scholar
  • 21 Li K, Wohlford-Lenane C, Perlman S. et al. Middle East respiratory syndrome coronavirus causes multiple organ damage and lethal disease in mice transgenic for human dipeptidyl peptidase 4. J Infect Dis 2016; 213 (05) 712-722
    CrossrefPubMedGoogle Scholar
  • 22 Netland J, Meyerholz DK, Moore S, Cassell M, Perlman S. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol 2008; 82 (15) 7264-7275
    CrossrefPubMedGoogle Scholar
  • 23 Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020; 92 (06) 552-555
    CrossrefPubMedGoogle Scholar
  • 24 Unni SK, Růžek D, Chhatbar C, Mishra R, Johri MK, Singh SK. Japanese encephalitis virus: from genome to infectome. Microbes Infect 2011; 13 (04) 312-321
    CrossrefPubMedGoogle Scholar
  • 25 Koyuncu OO, Hogue IB, Enquist LW. Virus infections in the nervous system. Cell Host Microbe 2013; 13 (04) 379-393
    CrossrefPubMedGoogle Scholar
  • 26 Desforges M, Le Coupanec A, Dubeau P. et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system?. Viruses 2019; 12 (01) 14
    CrossrefPubMedGoogle Scholar
  • 27 Romani L, Del Chierico F, Chiriaco M. et al. Gut mucosal and fecal microbiota profiling combined to intestinal immune system in neonates affected by intestinal ischemic injuries. Front Cell Infect Microbiol 2020; 10: 59
    CrossrefPubMedGoogle Scholar
  • 28 Zhao JM, Zhou GD, Sun YL. et al. [Clinical pathology and pathogenesis of severe acute respiratory syndrome]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2003; 17 (03) 217-221
    PubMedGoogle Scholar
  • 29 Cashion MF, Banks WA, Bost KL, Kastin AJ. Transmission routes of HIV-1 gp120 from brain to lymphoid tissues. Brain Res 1999; 822 (1-2) 26-33
    CrossrefPubMedGoogle Scholar
  • 30 Yin CH, Wang C, Tang Z, Wen Y, Zhang SW, Wang BE. [Clinical analysis of multiple organ dysfunction syndrome in patients suffering from SARS]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2004; 16 (11) 646-650
    PubMedGoogle Scholar
  • 31 Chen C, Zhang XR, Ju ZY. He, WF [Advances in the research of mechanism and related immunotherapy on the cytokine storm induced by coronavirus disease 2019]. Zhonghua Shao Shang Za Zhi 2020; 36 (00) 471-475
    PubMed
  • 32 Wan S, Yi Q, Fan S. et al. Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP). Medrxiv 2020; DOI: 10.1101/2020.02.10.20021832.
    CrossrefGoogle Scholar
  • 33 Abdennour L, Zeghal C, Dème M, Puybasset L. Interaction cerveau-poumon. [Interaction brain-lungs] Ann Fr Anesth Reanim 2012; 31 (06) e101-e107
    CrossrefPubMedGoogle Scholar
  • 34 Guo YR, Cao QD, Hong ZS. et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res 2020; 7 (01) 11
    CrossrefPubMedGoogle Scholar
  • 35 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (04) 844-847
    CrossrefPubMedGoogle Scholar
  • 36 Zhang Y, Xiao M, Zhang S. et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 2020; 382 (17) e38
    CrossrefPubMedGoogle Scholar
  • 37 Reinhold AK, Rittner HL. Barrier function in the peripheral and central nervous system-a review. Pflugers Arch 2017; 469 (01) 123-134
    CrossrefPubMedGoogle Scholar
  • 38 Wüthrich C, Batson S, Koralnik IJ. Lack of major histocompatibility complex class I upregulation and restrictive infection by JC virus hamper detection of neurons by T lymphocytes in the central nervous system. J Neuropathol Exp Neurol 2015; 74 (08) 791-803
    CrossrefPubMedGoogle Scholar
  • 39 Mao L, Jin H, Wang M. et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; e201127
    Google Scholar
  • 40 Helms J, Kremer S, Merdji H. et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 2020; 382 (23) 2268-2270
    CrossrefPubMedGoogle Scholar
  • 41 Li Y, Li M, Wang M, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol 2020;5(3):279-284
  • 42 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8 (05) 475-481
    CrossrefPubMedGoogle Scholar
  • 43 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
    CrossrefPubMedGoogle Scholar
  • 44 Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral haemorrhage: causative or coincidental?. New Microbes New Infect 2020; 35: 100669
    CrossrefPubMedGoogle Scholar
  • 45 Moriguchi T, Harii N, Goto J. et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020; 94: 55-58
    CrossrefPubMedGoogle Scholar
  • 46 Huang YH, Jiang D, Huang JT. SARS-CoV-2 detected in cerebrospinal fluid by PCR in a case of COVID-19 encephalitis. Brain Behav Immun 2020; 87: 149
    CrossrefPubMedGoogle Scholar
  • 47 Poyiadji N, Shahin G, Noujaim D. et al. COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology 2020; 296 (02) E119-E120
    CrossrefPubMedGoogle Scholar
  • 48 Zhao K, Huang J, Dai D, et al. Acute myelitis after SARSCoV- 2 infection: a case report. Medrxiv 2020. Doi: 10.1101/2020.03.16.20035105
  • 49 Sarma D, Bilello LA. A case report of acute transverse myelitis following novel coronavirus infection. Clin Pract Cases Emerg Med 2020; 4 (03) 321-323
    CrossrefPubMedGoogle Scholar
  • 50 Chen T, Wu D, Chen H. et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020; 368: m1091
    CrossrefPubMedGoogle Scholar
  • 51 Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (COVID-19): encephalopathy. Cureus 2020; 12 (03) e7352
    PubMedGoogle Scholar
  • 52 Sohal S, Mansur M. COVID-19 presenting with seizures. IDCases 2020; 20: e00782
    CrossrefPubMedGoogle Scholar
  • 53 Vollono C, Rollo E, Romozzi M. et al. Focal status epilepticus as unique clinical feature of COVID-19: A case report. Seizure 2020; 78: 109-112
    CrossrefPubMedGoogle Scholar
  • 54 Bagheri SHR, Asghari AM, Farhadi M. et al. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak. Medrxiv 2020; DOI: 10.1101/2020.03.23.20041889.
    CrossrefGoogle Scholar
  • 55 Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?. Lancet Neurol 2020; 19 (05) 383-384
    CrossrefPubMedGoogle Scholar
  • 56 Toscano G, Palmerini F, Ravaglia S. et al. Guillain-Barré syndrome associated with SARS- CoV-2. N Engl J Med 2020; 382 (26) 2574-2576
    CrossrefPubMedGoogle Scholar
  • 57 Wei H, Yin H, Huang M, Guo Z. The 2019 novel coronavirus pneumonia with onset of oculomotor nerve palsy: a case study. J Neurol 2020; 267 (05) 1550-1553
    CrossrefPubMedGoogle Scholar
  • 58 Gutiérrez-Ortiz C, Méndez-Guerrero A, Rodrigo-Rey S. et al. Miller Fisher syndrome and polyneuritis cranialis in COVID-19. Neurology 2020; 95 (05) e601-e605
    CrossrefPubMedGoogle Scholar
  • 59 Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID- 19): a multicenter European study. Eur Arch Otorhinolaryngol 2020;277(8):2251-226