Neurological manifestations associated with COVID- 19: a review

Main Article Content

Yasmim Berni Ferreira
Flávia Maria Ramos Freire
Victor Oliveira Araújo
Isadora Mônica Ponte de Oliveira
Lara Maria de Oliveira Paiva Freitas
Júlio César Claudino dos Santos

Abstract

The knowledge of the spinal cord irrigation is important for the therapeutic planning "COVID-19" is a potentially serious, highly transmissible infectious disease that was first identified in Wuhan, China in December 2019. Individuals infected with SARS-CoV-2 can evolve asymptomatically, with respiratory symptoms or with systemic manifestations affecting, for example, the nervous system. This review aims to discuss the neurological manifestations of SARS-CoV-2 infection, citing the prevalence of each. This study analyzed scientific articles published from 2010 to 2021 in the PubMed database. More than 35% of patients who contract the novel coronavirus develop neurological symptoms. SARS-CoV enters the brain mainly through the olfactory bulb and spreads rapidly via transneuronal route to other related areas such as cerebellum, insula, encephalon, vessels and nerves, and the brain parenchyma itself. This causes manifestations in the CNS (dizziness and ataxias), PNS (anosmia and ageusia), and the musculoskeletal system. Given existing knowledge of other coronaviruses and respiratory viruses, the wide range of CNS and PNS associations with COVID-19 is not surprising, and this is the focus of most current reports. Neurological complications, particularly encephalitis and stroke, can cause lifelong disability, requiring long-term care and substantial costs in the social and economic sphere.

Article Details

How to Cite
Ferreira, Y. B. ., Freire, F. M. R., Araújo, V. O. ., de Oliveira, I. M. P., Freitas, L. M. de O. P. ., & dos Santos, J. C. C. (2021). Neurological manifestations associated with COVID- 19: a review. Brazilian Journal of Case Reports, 1(4), 31–44. https://doi.org/10.52600/2763-583X.bjcr.2021.1.4.31-44
Section
Health Review
Author Biographies

Yasmim Berni Ferreira, Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS

Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS, Ceará, CE, Brazil.

Flávia Maria Ramos Freire, Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS

Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS, Ceará, CE, Brazil.

Victor Oliveira Araújo, Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS

Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS, Ceará, CE, Brazil.

Isadora Mônica Ponte de Oliveira, Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS

Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS, Ceará, CE, Brazil.

Lara Maria de Oliveira Paiva Freitas, Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS

Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS, Ceará, CE, Brazil.

Júlio César Claudino dos Santos, Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS

Faculdade de Medicina, Centro Universitário Christus, UNICHRISTUS, Ceará, CE, Brazil.

Universidade Federal de São Paulo, São Paulo, SP, Brasil.

Laboratório de Neurociências, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.

References

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. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77(6):683-690. doi: 10.1001/ jamaneurol.2020.1127.

Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci. 2020 Jul;41(7):1667-1671. doi: 10.1007/s10072-020-04486-3.

Liotta EM, Batra A, Clark JR, Shlobin NA, Hoffman SC, Orban ZS, Koralnik IJ. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol. 2020 Nov;7(11):2221-2230. doi: 10.1002/acn3.51210.

Meppiel E, Peiffer-Smadja N, Maury A, Bekri I, Delorme C, Desestret V, Gorza L, Hautecloque-Raysz G, Landre S, Lannuzel A, Moulin S, Perrin P, Petitgas P, SellaI F, Wang A, Tattevin P, de Broucker T; contributors to the NeuroCOVID registry. Neurologic manifestations associated with COVID-19: a multicentre registry. Clin Microbiol Infect. 2021 Mar;27(3):458-466. doi: 10.1016/j.cmi.2020.11.005.

Tsai ST, Lu MK, San S, Tsai CH. The Neurologic Manifestations of Coronavirus Disease 2019 Pandemic: A Systemic Review. Front Neurol. 2020 May 19;11:498. doi: 10.3389/fneur.2020.00498.

Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol. 2020 Aug 1;77(8):1018-1027. doi: 10.1001/jamaneurol.2020.2065.

Katal S, Balakrishnan S, Gholamrezanezhad A. Neuroimaging and neurologic findings in COVID-19 and other coronavirus infections: A systematic review in 116 patients. J Neuroradiol. 2021 Feb;48(1):43-50. doi: 10.1016/j.neurad.2020.06.007.

Pinna P, Grewal P, Hall JP, Tavarez T, Dafer RM, Garg R, Osteraas ND, Pellack DR, Asthana A, Fegan K, Patel V, Conners JJ, John S, Silva ID. Neurological manifestations and COVID-19: Experiences from a tertiary care center at the Frontline. J Neurol Sci. 2020 Aug 15;415:116969. doi: 10.1016/j.jns.2020.116969.

Sardu C, Gambardella J, Morelli MB, Wang X, Marfella R, Santulli G. Hypertension, Thrombosis, Kidney Failure, and Diabetes: Is COVID-19 an Endothelial Disease? A Comprehensive Evaluation of Clinical and Basic Evidence. J Clin Med. 2020 May 11;9(5):1417. doi: 10.3390/jcm9051417.

Harapan BN, Yoo HJ. Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19). J Neurol. 2021 Sep;268(9):3059-3071. doi: 10.1007/s00415-021-10406-y.

Soltani Zangbar H, Gorji A, Ghadiri T. A Review on the Neurological Manifestations of COVID-19 Infection: a Mechanistic View. Mol Neurobiol. 2021 Feb;58(2):536-549. doi: 10.1007/s12035-020-02149-0.

Yavarpour-Bali H, Ghasemi-Kasman M. Update on neurological manifestations of COVID-19. Life Sci. 2020 Sep 15;257:118063. doi: 10.1016/j.lfs.2020.118063.

World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19. 2020. Available from: https:// www.who.int/dg/speeches/detail/ who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19--11-march-2020.

Johns Hopkins University. COVID-19 Dashboard. The Center for Systems Science and Engineering (CSSE). Baltimore, Maryland: JHU, 2021 June 2 (real time). Available from: https://coronavirus.jhu.edu/ map.html.

Paybast S, Gorji R, Mavandadi S. Guillain-Barré Syndrome as a Neurological Complication of Novel COVID-19 Infection: A Case Report and Review of the Literature. Neurologist. 2020 Jul;25(4):101-103. doi: 10.1097/NRL.0000000000000291.

Zhou Z, Kang H, Li S, Zhao X. Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol. 2020 Aug;267(8):2179-2184. doi: 10.1007/s00415-020-09929-7.

Ibrahim W. Neurological manifestations in coronavirus disease 2019 (COVID-19) patients: a systematic review of literature. CNS Spectr. 2020 Oct 21:1-12. doi: 10.1017/S1092852920001935.

Garg RK. Spectrum of Neurological Manifestations in Covid-19: A Review. Neurol India. 2020 May-Jun;68(3):560-572. doi: 10.4103/0028-3886.289000.

Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K. Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clin Neurol Neurosurg. 2020 Jul;194:105921. doi: 10.1016/j.clineuro.2020.105921.

Iadecola C, Anrather J, Kamel H. Effects of COVID-19 on the Nervous System. Cell. 2020 Oct 1;183(1):16-27.e1. doi: 10.1016/j.cell.2020.08.028.

Luigetti M, Iorio R, Bentivoglio AR, Tricoli L, Riso V, Marotta J, Piano C, Primiano G, Zileri Del Verme L, Lo Monaco MR, Calabresi P; GEMELLI AGAINST COVID-19 group. Assessment of neurological manifestations in hospitalized patients with COVID-19. Eur J Neurol. 2020 Nov;27(11):2322-2328. doi: 10.1111/ene.14444.

Adil MT, Rahman R, Whitelaw D, Jain V, Al-Taan O, Rashid F, Munasinghe A, Jambulingam P. SARS-CoV-2 and the pandemic of COVID-19. Postgrad Med J. 2021 Feb;97(1144):110-116. doi: 10.1136/postgradmedj-2020-138386.

Roy D, Ghosh R, Dubey S, Dubey MJ, Benito-León J, Kanti Ray B. Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic. Can J Neurol Sci. 2021 Jan;48(1):9-24. doi: 10.1017/cjn.2020.173.

Yachou Y, El Idrissi A, Belapasov V, Ait Benali S. Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurol Sci. 2020 Oct;41(10):2657-2669. doi: 10.1007/s10072-020-04575-3.

Stefano GB, Ptacek R, Patackova H, et al. Selective Neuronal Mitochondrial Targeting in SARS-CoV-2 Infection Affects Cognitive Processes to Induce ‘Brain Fog’ and Results in Behavioral Changes that Favor Viral Survival. Med Sci Monit. 2021 Jan 25; 27: e930886. doi: 10.12659/MSM.930886.

Taylor AK, Kingstone T, Briggs TA, O'Donnell CA, Atherton H, Blane DN, Chew-Graham CA. 'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID. Health Expect. 2021 Jun;24(3):833-842. doi: 10.1111/hex.13223.

Hellmuth J, Barnett TA, Asken BM, Kelly JD, Torres L, Stephens ML, Greenhouse B, Martin JN, Chow FC, Deeks SG, Greene M, Miller BL, Annan W, Henrich TJ, Peluso MJ. Persistent COVID-19-associated neurocognitive symptoms in non-hospitalized patients. J Neurovirol. 2021 Feb;27(1):191-195. doi: 10.1007/s13365-021-00954-4. Epub 2021 Feb 2. PMID: 33528824; PMCID: PMC7852463.

Wang F, Kream RM, Stefano GB. Long-Term Respiratory and Neurological Sequelae of COVID-19. Med Sci Monit. 2020 Nov 1;26:e928996. doi: 10.12659/MSM.928996.

Mahalaxmi I, Kaavya J, Mohana Devi S, Balachandar V. COVID-19 and olfactory dysfunction: A possible associative approach towards neurodegenerative diseases. J Cell Physiol. 2021 Feb;236(2):763-770. doi: 10.1002/jcp.29937.

Kandemirli SG, Altundag A, Yildirim D, Tekcan Sanli DE, Saatci O. Olfactory Bulb MRI and Paranasal Sinus CT Findings in Persistent COVID-19 Anosmia. Acad Radiol. 2021 Jan;28(1):28-35. doi: 10.1016/j.acra.2020.10.006.

Nazari S, Azari Jafari A, Mirmoeeni S, Sadeghian S, Heidari ME, Sadeghian S, Assarzadegan F, Puormand SM, Ebadi H, Fathi D, Dalvand S. Central nervous system manifestations in COVID-19 patients: A systematic review and meta-analysis. Brain Behav. 2021 May;11(5):e02025. doi: 10.1002/brb3.2025.

Kamal M, Abo Omirah M, Hussein A, Saeed H. Assessment and characterisation of post-COVID-19 manifestations. Int J Clin Pract. 2021 Mar;75(3):e13746. doi: 10.1111/ijcp.13746.

Graham EL, Clark JR, Orban ZS, Lim PH, Szymanski AL, Taylor C, DiBiase RM, Jia DT, Balabanov R, Ho SU, Batra A, Liotta EM, Koralnik IJ. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 "long haulers". Ann Clin Transl Neurol. 2021 May;8(5):1073-1085. doi: 10.1002/acn3.51350.

Wang H, Tang X, Fan H, Luo Y, Song Y, Xu Y, Chen Y. Potential mechanisms of hemorrhagic stroke in elderly COVID-19 patients. Aging (Albany NY). 2020 Jun 11;12(11):10022-10034. doi: 10.18632/aging.103335.

Michel P, Hirt L, Strambo D. “Covid-19 et AVC: associés ou non ?’’. Revue Médicale Suisse. 2021 Apr 28; 17 (736):816-821.

Naval-Baudin P, Rodriguez I, Rubio-Maicas C, Pons-Escoda A, Viñas MMF, Nuñez A, Cardona P, Majos C, Cos M, Calvo N. COVID ‐ 19 e acidente vascular cerebral isquêmico: achados clínicos e de neuroimagem. Journal of Neuroimaging. 2020 Sep 28;31(1);62-66. doi: 10.1111/jon.12790.

Suzuki YJ, Nikolaienko SI, Shults NV, Gychka SG. COVID-19 patients may become predisposed to pulmonary arterial hypertension. Med Hypotheses. 2021 Feb;147:110483. doi: 10.1016/j.mehy.2021.110483.

Azevedo RB, Botelho BG, Hollanda JVG, Ferreira LVL, Junqueira de Andrade LZ, Oei SSML, Mello TS, Muxfeldt ES. Covid-19 and the cardiovascular system: a comprehensive review. J Hum Hypertens. 2021 Jan;35(1):4-11. doi: 10.1038/s41371-020-0387-4.

Rodríguez Y, Rojas M, Pacheco Y, Acosta-Ampudia Y, Ramírez-Santana C, Monsalve DM, Gershwin ME, Anaya JM. Guillain-Barré syndrome, transverse myelitis and infectious diseases. Cell Mol Immunol. 2018 Jun;15(6):547-562. doi: 10.1038/cmi.2017.142.

Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep;19(9):767-783. doi: 10.1016/S1474-4422(20)30221-0.

Lippi G, Wong J, Henry BM. Hypertension in patients with coronavirus disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med. 2020 Apr 30;130(4):304-309. doi: 10.20452/pamw.15272.

Vintila, I. Filip CR, Rociu C. Hypoxic-ischemic encephalopathy in adult. Acta Medica Transilvanica. 2010; 2(3):189-192.

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