Neurological Manifestations of COVID-19

Authors

  • Andrianto Selohandono Universitas Ahmad Dahlan, Yogyakarta

DOI:

https://doi.org/10.12928/admj.v2i1.3860

Keywords:

COVID-19, SARS-CoV-2, neurology, literature review

Abstract

COVID-19 disease has become a threat to global health. SARS-CoV-2 infection can cause damage to any other organs including the nervous system, which manifests as a neurological disorder. A number of neurological disorders have been reported in COVID-19 patients, including encephalopathy, stroke, myelitis, Guillain-Barre syndrome. The neurological manifestations in COVID-19 patients are varied and complex. A number of theories have been proposed to explain the pathomechanism behind the neurological diseases that develops in COVID-19 patients and are generally divided into direct and indirect effects of COVID-19. The direct routes involve invasion of the virus into the brain via olfactory, vascular pathways, or infiltration of infected immune cells; whereas indirect routes are the neurological consequences of systemic damage caused by viruses, such as inflammation, hypoxia, or hypercoagulable states. The neurological diseases experienced by COVID-19 patients can be caused by the pathophysiological process of the COVID-19 disease or other causes that coincide with viral infections.

Author Biography

Andrianto Selohandono, Universitas Ahmad Dahlan, Yogyakarta

Department of Neurology

References

Arbour, N., Day, R., Newcombe, J., Talbot, P.J., 2000. Neuroinvasion by Human Respiratory Coronaviruses. J. Virol. 74, 8913–8921. https://doi.org/10.1128/JVI.74.19.8913-8921.2000
Cantuti-Castelvetri, L., Ojha, R., Pedro, L.D., Djannatian, M., Franz, J., Kuivanen, S., Kallio, K., Kaya, T., Anastasina, M., Smura, T., Levanov, L., Szirovicza, L., Tobi, A., Kallio-Kokko, H., Österlund, P., Joensuu, M., Meunier, F.A., Butcher, S., Winkler, M.S., Mollenhauer, B., Helenius, A., Gokce, O., Teesalu, T., Hepojoki, J., Vapalahti, O., Stadelmann, C., Balistreri, G., Simons, M., 2020. Neuropilin-1 facilitates SARS-CoV-2 cell entry and provides a possible pathway into the central nervous system (preprint). Microbiology. https://doi.org/10.1101/2020.06.07.137802
Carsana, L., Sonzogni, A., Nasr, A., Rossi, R.S., Pellegrinelli, A., Zerbi, P., Rech, R., Colombo, R., Antinori, S., Corbellino, M., Galli, M., Catena, E., Tosoni, A., Gianatti, A., Nebuloni, M., 2020. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect. Dis. 20, 1135–1140. https://doi.org/10.1016/S1473-3099(20)30434-5
Chen, G., Wu, D., Guo, W., Cao, Y., Huang, D., Wang, H., Wang, T., Zhang, Xiaoyun, Chen, H., Yu, H., Zhang, Xiaoping, Zhang, M., Wu, S., Song, J., Chen, T., Han, M., Li, S., Luo, X., Zhao, J., Ning, Q., 2020. Clinical and immunological features of severe and moderate coronavirus disease 2019. J. Clin. Invest. 130, 2620–2629. https://doi.org/10.1172/JCI137244
Dantzer, R., 2018. Neuroimmune Interactions: From the Brain to the Immune System and Vice Versa. Physiol. Rev. 98, 477–504. https://doi.org/10.1152/physrev.00039.2016
Diao, B., Wang, C., Tan, Y., Chen, X., Liu, Ying, Ning, L., Chen, L., Li, M., Liu, Yueping, Wang, G., Yuan, Z., Feng, Z., Zhang, Y., Wu, Y., Chen, Y., 2020. Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19). Front. Immunol. 11, 827. https://doi.org/10.3389/fimmu.2020.00827
Dixon, L., Varley, J., Gontsarova, A., Mallon, D., Tona, F., Muir, D., Luqmani, A., Jenkins, I.H., Nicholas, R., Jones, B., Everitt, A., 2020. COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia. Neurol. - Neuroimmunol. Neuroinflammation 7, e789. https://doi.org/10.1212/NXI.0000000000000789
Dosch, S.F., Mahajan, S.D., Collins, A.R., 2009. SARS coronavirus spike protein-induced innate immune response occurs via activation of the NF-kappaB pathway in human monocyte macrophages in vitro. Virus Res. 142, 19–27. https://doi.org/10.1016/j.virusres.2009.01.005
Dubé, M., Le Coupanec, A., Wong, A.H.M., Rini, J.M., Desforges, M., Talbot, P.J., 2018. Axonal Transport Enables Neuron-to-Neuron Propagation of Human Coronavirus OC43. J. Virol. 92. https://doi.org/10.1128/JVI.00404-18
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, 767–783. https://doi.org/10.1016/S1474-4422(20)30221-0
Erickson, M.A., Banks, W.A., 2018. Neuroimmune Axes of the Blood-Brain Barriers and Blood-Brain Interfaces: Bases for Physiological Regulation, Disease States, and Pharmacological Interventions. Pharmacol. Rev. 70, 278–314. https://doi.org/10.1124/pr.117.014647
Garg, R.K., Paliwal, V.K., Gupta, A., 2021. Encephalopathy in patients with COVID‐19: A review. J. Med. Virol. 93, 206–222. https://doi.org/10.1002/jmv.26207
Grasselli, G., Zangrillo, A., Zanella, A., Antonelli, M., Cabrini, L., Castelli, A., Cereda, D., Coluccello, A., Foti, G., Fumagalli, R., Iotti, G., Latronico, N., Lorini, L., Merler, S., Natalini, G., Piatti, A., Ranieri, M.V., Scandroglio, A.M., Storti, E., Cecconi, M., Pesenti, A., COVID-19 Lombardy ICU Network, 2020. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 323, 1574–1581. https://doi.org/10.1001/jama.2020.5394
Helms, J., Tacquard, C., Severac, F., Leonard-Lorant, I., Ohana, M., Delabranche, X., Merdji, H., Clere-Jehl, R., Schenck, M., Fagot Gandet, F., Fafi-Kremer, S., Castelain, V., Schneider, F., Grunebaum, L., Anglés-Cano, E., Sattler, L., Mertes, P.-M., Meziani, F., CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis), 2020. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 46, 1089–1098. https://doi.org/10.1007/s00134-020-06062-x
Hess, D.C., Eldahshan, W., Rutkowski, E., 2020. COVID-19-Related Stroke. Transl. Stroke Res. 11, 322–325. https://doi.org/10.1007/s12975-020-00818-9
Iadecola, C., Anrather, J., Kamel, H., 2020. Effects of COVID-19 on the Nervous System. Cell 183, 16-27.e1. https://doi.org/10.1016/j.cell.2020.08.028
Inglese, M., Salvi, F., Iannucci, G., Mancardi, G.L., Mascalchi, M., Filippi, M., 2002. Magnetization transfer and diffusion tensor MR imaging of acute disseminated encephalomyelitis. AJNR Am. J. Neuroradiol. 23, 267–272.
Jadali, Z., 2020. Neurologic manifestations of COVID-19: what can we learn from other coronaviruses. Egypt. J. Neurol. Psychiatry Neurosurg. 56, 106. https://doi.org/10.1186/s41983-020-00240-w
Khatoon, F., Prasad, K., Kumar, V., 2020. Neurological manifestations of COVID-19: available evidences and a new paradigm. J. Neurovirol. 26, 619–630. https://doi.org/10.1007/s13365-020-00895-4
Langley, L., Zeicu, C., Whitton, L., Pauls, M., 2020. Acute disseminated encephalomyelitis (ADEM) associated with COVID-19. BMJ Case Rep. 13, e239597. https://doi.org/10.1136/bcr-2020-239597
Lu, R., Zhao, X., Li, J., Niu, P., Yang, B., Wu, H., Wang, W., Song, H., Huang, B., Zhu, N., Bi, Y., Ma, X., Zhan, F., Wang, L., Hu, T., Zhou, H., Hu, Z., Zhou, W., Zhao, L., Chen, J., Meng, Y., Wang, J., Lin, Y., Yuan, J., Xie, Z., Ma, J., Liu, W.J., Wang, D., Xu, W., Holmes, E.C., Gao, G.F., Wu, G., Chen, W., Shi, W., Tan, W., 2020. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet 395, 565–574. https://doi.org/10.1016/S0140-6736(20)30251-8
Mahalakshmi, A.M., Ray, B., Tuladhar, S., Bhat, A., Paneyala, S., Patteswari, D., Sakharkar, M.K., Hamdan, H., Ojcius, D.M., Bolla, S.R., Essa, M.M., Chidambaram, S.B., Qoronfleh, M.W., 2021. Does COVID‐19 contribute to development of neurological disease? Immun. Inflamm. Dis. 9, 48–58. https://doi.org/10.1002/iid3.387
Nampoothiri, S., Sauve, F., Ternier, G., Fernandois, D., Coelho, C., Imbernon, M., Deligia, E., Perbet, R., Florent, V., Baroncini, M., Pasquier, F., Trottein, F., Maurage, C.-A., Mattot, V., Giacobini, P., Rasika, S., Prevot, V., 2020. The hypothalamus as a hub for SARS-CoV-2 brain infection and pathogenesis (preprint). Neuroscience. https://doi.org/10.1101/2020.06.08.139329
Nepal, G., Rehrig, J.H., Shrestha, G.S., Shing, Y.K., Yadav, J.K., Ojha, R., Pokhrel, G., Tu, Z.L., Huang, D.Y., 2020. Neurological manifestations of COVID-19: a systematic review. Crit. Care 24, 421. https://doi.org/10.1186/s13054-020-03121-z
Pohl, D., Alper, G., Van Haren, K., Kornberg, A.J., Lucchinetti, C.F., Tenembaum, S., Belman, A.L., 2016. Acute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome. Neurology 87, S38-45. https://doi.org/10.1212/WNL.0000000000002825
Qin, C., Zhou, L., Hu, Z., Zhang, S., Yang, S., Tao, Y., Xie, C., Ma, K., Shang, K., Wang, W., Tian, D.-S., 2020. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am. 71, 762–768. https://doi.org/10.1093/cid/ciaa248
Rahimi, K., 2020. Guillain-Barre syndrome during COVID-19 pandemic: an overview of the reports. Neurol. Sci. 41, 3149–3156. https://doi.org/10.1007/s10072-020-04693-y
Solomon, I.H., Normandin, E., Bhattacharyya, S., Mukerji, S.S., Keller, K., Ali, A.S., Adams, G., Hornick, J.L., Padera, R.F., Sabeti, P., 2020. Neuropathological Features of Covid-19. N. Engl. J. Med. 383, 989–992. https://doi.org/10.1056/NEJMc2019373
Solomon, T., Michael, B.D., Smith, P.E., Sanderson, F., Davies, N.W.S., Hart, I.J., Holland, M., Easton, A., Buckley, C., Kneen, R., Beeching, N.J., National Encephalitis Guidelines Development and Stakeholder Groups, 2012. Management of suspected viral encephalitis in adults--Association of British Neurologists and British Infection Association National Guidelines. J. Infect. 64, 347–373. https://doi.org/10.1016/j.jinf.2011.11.014
Solomon, T., Willison, H., 2003. Infectious causes of acute flaccid paralysis. Curr. Opin. Infect. Dis. 16, 375–381. https://doi.org/10.1097/00001432-200310000-00002
Song, E., Zhang, C., Israelow, B., Lu-Culligan, A., Prado, A.V., Skriabine, S., Lu, P., Weizman, O.-E., Liu, F., Dai, Y., Szigeti-Buck, K., Yasumoto, Y., Wang, G., Castaldi, C., Heltke, J., Ng, E., Wheeler, J., Alfajaro, M.M., Levavasseur, E., Fontes, B., Ravindra, N.G., Van Dijk, D., Mane, S., Gunel, M., Ring, A., Jaffar Kazmi, S.A., Zhang, K., Wilen, C.B., Horvath, T.L., Plu, I., Haik, S., Thomas, J.-L., Louvi, A., Farhadian, S.F., Huttner, A., Seilhean, D., Renier, N., Bilguvar, K., Iwasaki, A., 2020. Neuroinvasion of SARS-CoV-2 in human and mouse brain (preprint). Microbiology. https://doi.org/10.1101/2020.06.25.169946
Thachil, J., Tang, N., Gando, S., Falanga, A., Cattaneo, M., Levi, M., Clark, C., Iba, T., 2020. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J. Thromb. Haemost. JTH 18, 1023–1026. https://doi.org/10.1111/jth.14810
Vanhorebeek, I., Latronico, N., Van den Berghe, G., 2020. ICU-acquired weakness. Intensive Care Med. 46, 637–653. https://doi.org/10.1007/s00134-020-05944-4
Varatharaj, A., Thomas, N., Ellul, M.A., Davies, N.W.S., Pollak, T.A., Tenorio, E.L., Sultan, M., Easton, A., Breen, G., Zandi, M., Coles, J.P., Manji, H., Al-Shahi Salman, R., Menon, D.K., Nicholson, T.R., Benjamin, L.A., Carson, A., Smith, C., Turner, M.R., Solomon, T., Kneen, R., Pett, S.L., Galea, I., Thomas, R.H., Michael, B.D., Allen, C., Archibald, N., Arkell, J., Arthur-Farraj, P., Baker, M., Ball, H., Bradley-Barker, V., Brown, Z., Bruno, S., Carey, L., Carswell, C., Chakrabarti, A., Choulerton, J., Daher, M., Davies, R., Di Marco Barros, R., Dima, S., Dunley, R., Dutta, D., Ellis, R., Everitt, A., Fady, J., Fearon, P., Fisniku, L., Gbinigie, I., Gemski, A., Gillies, E., Gkrania-Klotsas, E., Grigg, J., Hamdalla, H., Hubbett, J., Hunter, N., Huys, A.-C., Ihmoda, I., Ispoglou, S., Jha, A., Joussi, R., Kalladka, D., Khalifeh, H., Kooij, S., Kumar, G., Kyaw, S., Li, L., Littleton, E., Macleod, M., Macleod, M.J., Madigan, B., Mahadasa, V., Manoharan, M., Marigold, R., Marks, I., Matthews, P., Mccormick, M., Mcinnes, C., Metastasio, A., Milburn-McNulty, P., Mitchell, C., Mitchell, D., Morgans, C., Morris, H., Morrow, J., Mubarak Mohamed, A., Mulvenna, P., Murphy, L., Namushi, R., Newman, E., Phillips, W., Pinto, A., Price, D.A., Proschel, H., Quinn, T., Ramsey, D., Roffe, C., Ross Russell, A., Samarasekera, N., Sawcer, S., Sayed, W., Sekaran, L., Serra-Mestres, J., Snowdon, V., Strike, G., Sun, J., Tang, C., Vrana, M., Wade, R., Wharton, C., Wiblin, L., Boubriak, I., Herman, K., Plant, G., 2020. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry 7, 875–882. https://doi.org/10.1016/S2215-0366(20)30287-X
Wenting, A., Gruters, A., van Os, Y., Verstraeten, S., Valentijn, S., Ponds, R., de Vugt, M., 2020. COVID-19 Neurological Manifestations and Underlying Mechanisms: A Scoping Review. Front. Psychiatry 11, 860. https://doi.org/10.3389/fpsyt.2020.00860
Yang, L., Han, Y., Nilsson-Payant, B.E., Gupta, V., Wang, P., Duan, X., Tang, X., Zhu, J., Zhao, Z., Jaffré, F., Zhang, T., Kim, T.W., Harschnitz, O., Redmond, D., Houghton, S., Liu, C., Naji, A., Ciceri, G., Guttikonda, S., Bram, Y., Nguyen, D.-H.T., Cioffi, M., Chandar, V., Hoagland, D.A., Huang, Y., Xiang, J., Wang, H., Lyden, D., Borczuk, A., Chen, H.J., Studer, L., Pan, F.C., Ho, D.D., tenOever, B.R., Evans, T., Schwartz, R.E., Chen, S., 2020. A Human Pluripotent Stem Cell-based Platform to Study SARS-CoV-2 Tropism and Model Virus Infection in Human Cells and Organoids. Cell Stem Cell 27, 125-136.e7. https://doi.org/10.1016/j.stem.2020.06.015

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2021-12-29

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Selohandono, A. (2021). Neurological Manifestations of COVID-19. Ahmad Dahlan Medical Journal, 2(1), 19–33. https://doi.org/10.12928/admj.v2i1.3860

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