Main neurological manifestations associated with SARS-CoV-2 (COVID-19): a narrative review of the literature
DOI:
https://doi.org/10.33448/rsd-v11i7.30359Keywords:
SARS-CoV-2; COVID-19; Neurological manifestations; Health education.Abstract
Introduction: Infection with the new coronavirus has a heterogeneous, multifactorial character and, despite greater respiratory compromise, it constitutes a multisystem involvement that can affect the nervous system, generating complex sequelae. Objective: to address the main neurological manifestations of COVID-19, for a better understanding of the disease by health professionals and academics. Methodology: this is a literature narrative, carried out from the search for scientific publications indexed in the databases: PubMed, MEDLINE, Scielo, CDSR, Google Scholar, BVS and EBSCO. The following descriptors were used: with the descriptors "SARS-CoV-2", "neurological symptoms", "COVID-19", "spike protein", "ACE2". At the end of the searches, 40 publications met the eligibility criteria and were selected to compose the study. Results: in view of the findings extracted from the selected studies, it was noticed that the most frequently reported neurological manifestations are: headache, anosmia, ageusia and occurrence of cerebrovascular events (CVA, CVT). In addition, SARS-CoV-2 infection has also been linked as a risk factor for the occurrence of Guillain-Barré Syndrome, encephalitis, and changes in levels of consciousness. Conclusion: this study allowed us to reflect on the variety of neurological manifestations caused by COVID-19, as well as the complexity involved in the management of this disease. It is suggested to carry out more detailed studies on the subject in order to better clarify the findings and clinical management to be adopted.
References
Abdullahi, A., Candan, S. A., Abba, M. A., Bello, A. H., Alshehri, M. A., Afamefuna Victor, E., Umar, N. A., & Kundakci, B. (2020). Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis. Front Neurol. 11, 687.
Al-Mufti, F., Amuluru, K., Sahni, R., Bekelis, K., Karimi, R., Gulnick, J., Cooper, J., Overby, P., Nuoman, R., Tiwari, A., Berekashvili, K., Dangayach, N., Liang, J., Gupta, G., Khandelwal, P., Dominguez, J. F., Sursal, T., Kamal, H., Dakay, K., Taylor, B., Gulko, E., El-Ghanem, M., Mayer S. A., & Gandhi, C. (2021). Cerebral venous thrombosis in COVID-19: a New York metropolitan cohort study. American Journal of Neuroradiology, 1 (1), 1-5.
Andersen, K. G., Rambaut, A., Lipkin, W. I., Holmes, E. C., & Garry, R. F. (2020). The proximal origin of SARS-CoV-2. Nat Med, 26 (4), 450-452.
Angius, F., Pala, G., & Manzin, A. (2021). SARS-CoV-2 and Its Variants: The Pandemic of Unvaccinated. Front Microbiol. 12, 749634.
Baig, A. M., Khaleeq, A., Ali, U., & Syeda, H. (2020). Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci, 11 (7), 995-8.
Beach, S. R., Praschan, N. C., Hogan, C., Dotson, S., Merideth, F., Kontos, N., Fricchione, G. L., & Smith, F. A. (2020). Delirium in COVID-19: A case series and exploration of potential mechanisms for central nervous system involvement. Gen Hosp Psychiatry. 65, 47–53.
Beyrouti, R., Adams, M. E., Benjamin, L., Cohen, H., Farmer, S. F., Goh, Y. Y., Humphries, F., Jäger, H. R., Losseff, N. A., Perry, R. J., Shah, S., Simister, R. J., Turner, D., Chandratheva, A., & Werring, D. J. (2020). Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry. 91 (8), 889-891.
Bikdeli, B., Madhavan, M. V., Jimenez, D., Chuich, T., Dreyfus, I., Driggin, E., Nigoghossian, C., Ageno, W., Madjid, M., Guo, Y., Tang, L. V., Hu, Y., Giri, J., Cushman, M., Quéré, I., Dimakakos, E. P., Gibson, C. M., Lippi, G., Favaloro, E. J., Fareed, J., Caprini, J. A., Tafur, A. J., Burton, J. R., Francese, D. P., Wang, E. Y., Falanga, A., McLintock, C., Hunt, B. J., Spyropoulos, A. C., Barnes, G. D., Eikelboom, J. W., Weinberg, I., Schulman, S., Carrier, M., Piazza, G., Beckman, J. A., Steg, P. G., Stone, G. W., Rosenkranz, S., Goldhaber, S. Z., Parikh, S. A., Monreal, M., Krumholz, H. M., Konstantinides, S. V., Weitz, J. I., Lip, G. Y. H., & Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. (2020). COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol. S0735-1097 (20), 35008-7.
Camdessanche, J. P., Morel, J., Pozzetto, B., Paul, S., Tholance, Y., & Botelho-Nevers, E. (2020). COVID-19 may induce Guillain-Barré syndrome. Rev Neurol (Paris). 176 (6), 516-518.
Das, G., Mukherjee, N., & Ghosh, S. (2020). Neurological Insights of COVID-19 Pandemic. ACS Chem Neurosci, 11 (9), 1206-1209.
DeVere R. (2017) Disorders of taste and smell. Continuum (Minneap Minn). 23 (2, Selected Topics in Outpatient Neurology), 421-46
Ding, Q., Lu, P., Fan, Y., Xia, Y., & Liu, M. (2020). The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan, China. J Med Virol. 92 (9), 1549-1555.
Ellul, M. A., & Solomon, T. (2018). Acute encephalitis – diagnosis and management. Clin Med. 18 (2), 155-159.
Ellul, M. A., Benjamin, L., Singh, B., Lant, S., Michael, B. D., Easton, A., Kneen, R., Defres, S., Sejvar, J., & Solomon, T. (2020). Neurological associations of COVID-19. Lancet Neurol. 19 (9), 767–783.
Favas, T. T., Dev, P., Chaurasia, R. N., Chakravarty, K., Mishra, R., Joshi, D., Mishra, V. N., Kumar, A., Singh, V. K., Pandey, M., & Pathak, A. (2020). Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci. 41 (12), 3437–3470.
Galán, A. V., Del Saz Saucedo, P., Peinado, P. F., & Botia, P. E. (2020). Síndrome de Guillain-Barré asociado a infección por SARS-CoV-2. Neurología, 35, 0-0.
Gemelli Against COVID-19 Post-Acute Care Study Group. (2020). Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res. 32 (8), 1613-1620.
Giacomelli, A., Pezzati, L., Conti, F., Bernacchia, D., Siano, M., Oreni, L., Rusconi, S., Gervasoni, C., Ridolfo, A. L., Rizzardini, G., Antinori, S., & Galli, M. (2020). Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis. 71, (15), 89-890.
Giannis, D., Ziogas, I. A., & Gianni, P. (2020). Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. Journal of Clinical Virology, 127, 104362.
Gomes, C. (2020). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Braz. J. Implantol, 2 (3). https://bjihs.emnuvens.com.br/bjihs/article/view/172.
González-Candelas, F., Shaw, M. A., Phan, T., Kulkarni-Kale, U., Paraskevis, D., Luciani, F., Kimura, H., & Sironi, M. (2021). One year into the pandemic: Short-term evolution of SARS-CoV-2 and emergence of new lineages Infect Genet Evol. 92, 104869.
Guan, W.-J., Ni, Z., Hu, Y., Liang, W., Ou, C., He, J., Liu, L., Shan, H., Lei, C., Hui, D. S. C., Du, B., Li, L., Zeng, G., Yuen, K.-Y., Chen, R., Tang, C., Wang, T., Chen, P., Xiang, J., Li, S., Jin-lin Wang, Z. Liang, Y. Peng, L. Wei, Y. Liu, Ya-hua Hu, P. Peng, Wang, J., Liu, J., Chen, Z., Li, G., Zheng, Z., Qiu, S., Luo, J., Ye, C., Zhu, S., & Zhong, N. (2020). Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 382 (18), 1708-1720.
Hasöksüz, M., Kiliç, S., & Saraç, F. (2020). Coronaviruses and SARS-CoV-2. Turk J Med Sci, 12 (4), 23-43.
Helbok, R., Chou, S. H., Beghi, E., Mainali, S., Frontera, J., Robertson, C., Fink, E., Schober, M., Moro, E., McNett, M., Bassetti, C. L.; GCS-NeuroCOVID consortium, & EAN COVID task force. (2020). NeuroCOVID: it’s time to join forces globally. Lancet Neurol. 19 (10), 805–6.
Iser, B. P. M., Silva, I., Raymundo, V. T., Poleto, M. B., Schuelter-Trevisol, F., & Bobinski, F. (2020). Definição de caso suspeito da COVID-19: uma revisão narrativa dos sinais e sintomas mais frequentes entre os casos confirmados. Epidemiol. Serv. Saúde, 29 (3), e2020233.
Islam, M. F.; Cotler, J., &. Jason, L. A. Post viral fatigue and COVID-19: lessons from past epidemics. Fatigue: Biomed. Health Behav. 8 (2), 61-69.
Jin, H., Hong, C., Chen, S., Zhou, Y., Wang, Y., Mao, L., Li, Y., He, Q., Li, M., Su, Y., Wang, D., Wang, L., & Hu, B. (2020). Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke Vasc Neurol. 5 (2), 146-151.
Kochi, A. N., Tagliari, A. P., Forleo, G. B., Fassini, G. M., & Tondo, C. (2020). Cardiac and arrhythmic complications in patients with COVID‐19. J Cardiovasc Electrophysiol. 31 (5), 1003-1008.
Kolifarhood, G., Aghaali, M., Mozafar Saadati, H., Taherpour, N., Rahimi, S., Izadi, N., & Hashemi Nazari, S. S. (2020). Epidemiological and clinical aspects of COVID-19: a narrative review. Arch Acad Emerg Med, 8 (1), e41.
Lauer, S. A., Grantz, K. H., Bi, Q., Jones, F. K., Zheng, Q., Meredith, H. R., Azman, A. S., Reich, N. G., & Lessler, J. (2020). The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med, 172 (9), 577-582.
Lechien, J. R., Chiesa-Estomba, C. M., De Siati, D. R., Horoi, M., Le Bom, S. D., Rodriguez, A., Dequanter, D., Blecic, S., El Afia, F., Distinguin, L., Chekkoury-Idrissi, Y., Hans, S., Delgado, I. L., Calvo-Henriquez, C., Lavigne, P., Falanga, C., Barillari, M. R., Cammaroto, G., Khalife, M., Leich, P., Souchay, C., Rossi, C., Journe, F., Hsieh, J., Edjlali, M., Carlier, R., Ris, L., Lovato, A., De Filippis, C., Coppee, F., Fakhry, N., Ayad, T., & Saussez, S. (2020). 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. 277, (8), 2251-2261.
Lee, J. M., & Lee, S. J. (2020). Olfactory and Gustatory Dysfunction in a COVID-19 Patient with Ankylosing Spondylitis Treated with Etanercept: Case Report. J Korean Med Sci. 35 (21), e201.
Lennon, J. C. (2020). Neurologic and Immunologic Complications of COVID-19: Potential Long-Term Risk Factors for Alzheimer’s Disease. J Alzheimers Dis Rep. 4, (1), 217-221
Ling, L., So, C., Shum, H. P., Chan, P. K. S., Lai, C. K. C., Kandamby, D. H., Ho, E., So, D., Yan, W. W., Lui, G., Leung, W. S., Chan, M. C., & Gomersall, C. D. (2020). Critically ill patients with COVID-19 in Hong Kong: a multicentre retrospective observational cohort study. Crit Care Resusc. 22 (2), 119-125.
Lopes, J. (2020). Complicações neurológicas em pacientes infectados por Sars-Cov-2 (COVID-19). Revista Atena. 1 (6), 60-72.
Loureiro B. B., Barros J. A. A, Crestani, I., Costa, C. F., & Montijo, M. M. (2021). Trombose Venosa Cerebral Pós COVID-19. In: II Congresso On-line de Neurocirurgia e Neurologia, 2ª edição, Anais...
Malik, Y. A. (2020). Properties of Coronavirus and SARS-CoV-2. Malays. J.Pathol, 42 (1), 3-11.
Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., Miao, X., Li, Y., & Hu, B. (2020). Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 77 (6), 683-690.
McGonagle, D., Sharif, K., O'Regan, A., & Bridgewood, C. (2020). The role of cytokines including Interleukin-6 in COVID-19 induced pneumonia and Macrophage Activation Syndrome-Like Disease. Autoimmun Rev. 19 (6), 102537.
Mehta, P., McAuley, D., Brown, M., Sanchez, E., Tattersall, R. S., & Manson, J. J., on behalf of the HLH Across Speciality Collaboration, UK. (2020). COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 395 (10229), 1033-1034.
Misra, S., Kolappa, K., Prasad, M., Radhakrishnan, D., Thakur, K. T., Solomon, T., Michael, B. D., Winkler, A. S., Beghi, E., Guekht, A., Pardo, C. A., Wood, G. K., Hsiang-Yi Chou, S., Fink, E. L., Schmutzhard, E., Kheradmand, A., Hoo, F. K., Kumar, A., Das, A., Srivastava, A. K., Agarwal, A., Dua, T., & Prasad, K. (2021). Frequency of neurological manifestations in COVID-19: a systematic review and meta-analysis. Neurology. 97 (23), e2269-e2281.
Montalvan, V., Lee, J., Bueso, T., De Toledo, J., & Rivas, K. (2020). Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clin Neurol Neurosurg. 194, 105921.
Moriguchi, T., Harii, N., Goto, J., Harada, D., Sugawara, H., Takamino, J., Ueno, M., Sakata, H., Kondo, K., Myose, N., Nakao, A., Takeda, M., Haro, H., Inoue, O., Suzuki-Inoue, K., Kubokawa, K., Ogihara, S., Sasaki, T., Kinouchi, H., Kojin, H., Ito, M., Onishi, H., Shimizu, T., Sasaki, Y., Enomoto, N., Ishihara, H., Furuya, S., Yamamoto, T., & Shimada, S. (2020). A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 94, 55-58.
Munhoz, R. P., Pedroso, J. L., Nascimento, F. A., Almeida, S. M., Barsottini, O. G. P., Cardoso, F. E. C., & Teive, H. A. G. (2020). Neurological complications in patients with SARS-CoV-2 infection: a systematic review. Arq Neuropsiquiatr. 78 (5), 290-300.
Needham, E. J., Chou, S. H. Y., Coles, A. J., & Menon, D. K. (2020). Neurological Implications of COVID-19 Infections. J Neurocrit Care, 32 (3), 667-71.
Ottaviani, D., Boso, F., Tranquillini, E., Gapeni, I., Pedrotti, G., Cozzio, S., Guarrera, G. M., & Giometto, B. (2020). Early Guillain-Barré syndrome in coronavirus disease 2019 (COVID-19): a case report from an Italian COVID-hospital. Neurol Sci. 41, (6), 1351-1354.
Paniz‐Mondolfi, A., Bryce, C., Grimes, Z., Gordon, R. E., Reidy, J., Lednicky, J., Sordillo, E. M., & Fowkes, M. (2020). Central nervous system involvement by severe acute respira - tory syndrome coronavirus ‐2 (SARS‐CoV‐2). J Med Virol. 92, 699-702.
Papa, S. M., Brundin, P., Fung, V. S. C., Kang, U. J., Burn, D. J., Colosimo, C., Chiang, H. L., Alcalay, R. N., Trenkwalder, C., & MDS-Scientific Issues Committee. (2020). Impact of the COVID-19 Pandemic on Parkinson's Disease and Movement Disorders. Mov Disord. 35 (5), 711-715.
Perrin, R., Riste, L., Hann, M., Walther, A., Mukherjee, A., & Heald, A. (2020). Into the looking glass: Post-viral syndrome post COVID-19. Med Hypotheses. 144, 110055.
Pleasure, S. J., Green, A. J., & Josephson, S. A. (2020). The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection: Neurologists Move to the Frontlines. JAMA Neurol. 77 (6), 679-680.
Poillon, G., Obadia, M., Perrin, M., Savatovsky, J., & Lecler, A. (2021). Cerebral venous thrombosis associated with COVID-19 infection: Causality or coincidence? Journal of Neuroradiology, 48, (2), 121-124.
Poyiadji, N., Shahin, G., Noujaim, D., Stone, M., Patel, S., & Griffith, B. (2020). COVID-19- associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 31, 201187.
Prazer, S. J., Green, A. J., & Josephson, S. A. (2020). The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection: Neurologists Move to the Frontlines. JAMA Neurol. 77 (6), 679–680.
Salian, V. S., Wright, J. A, Vedell, P. T., Nair, S., Li, C., Kandimalla, M., Tang, X., Carmona Porquera, E. M., Kalari, K. R., & Kandimalla, K. K. (2021). COVID-19 Transmission, Current Treatment, and Future Therapeutic Strategies. Mol Pharm. 18 (3), 754-771.
Sharifian-Dorche, M., Huot, P., Osherov, M., Wen, D., Saveriano, A., Giacomini, P. S., Antel, J. P., & Mowla, A. Neurological complications of coronavirus infection, a comparative review and lessons learned during the COVID-19 pandemic. J Neurol Sci. 417, 117085.
Toscano, G., Palmerini, F., Ravaglia, S., Ruiz, L., Invernizzi, P., Cuzzoni, M. G., Franciotta, D., Baldanti, F., Daturi, R., Postorino, P., Cavallini, A., & Micieli, G. (2020). Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med, 382, (26), 2574-2576.
Vandervorst, F., Guldolf, K., Peeters, I., Vanderhasselt, T., Michiels, K., Berends, K. J., Van Laethem, J., Pipeleers, L., Vincken, S., Seynaeve, L., & Engelborghs, S. (2020). Encephalitis associated with the SARS-CoV-2 virus: A case report. Interdiscip Neurosurg. 22, 100821.
Velavan, T. P., & Meyer, C. G. (2020). The COVID‐19 epidemic. Trop Med Int Health, 25 (3), 278-80.
Wang, L. (2018). Guillain-Barre Syndrome following viral infections: considerations for future treatment and research. Explor Res Hypothesis Med. v. 3, n. 1, p. 4-5, 2018.
Wang, C., Horby, P. W., Hayden, F. G., & Gao, G. F. (2020). A novel coronavirus outbreak of global health concern. Lancet, 395 (10223), 470-73.
Wang, Z., Yang, Y., Liang, X., Gao, B., Liu, M., Li, W., Chen, Z., & Wang, Z. (2020). COVID-19 Associated Ischemic Stroke and Hemorrhagic Stroke: Incidence, Potential Pathological Mechanism, and Management. Front Neurol. 11, 1152.
Wu, Y. C., Chen, C. S., & Chan, Y. J. (2020). The outbreak of COVID-19: An overview. Journal of the Chinese Medical Association. 83 (3), 217-220.
Xiong, M., Liang, X., & Wei, Y. D. (2020). Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. British Journal of Haematology, 189(6), 1050–1052.
Zhao, H., Shen, D., Zhou, H., Liu, J., & Chen, S. (2020). Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 19, (5), 383-4.
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