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SARS-CoV-2, which causes COVID-19, belongs to the genus
β coronavirus.
There are a variety of coronavirus strains with varying clinical severity, ranging from the common cold to severe acute respiratory distress syndrome (SARS) and Middle East respiratory syndrome (MERS).
While SARS-CoV-2 is known to affect the respiratory system, the virus has shown the ability to spread rapidly throughout the body, affecting multiple organ systems and severely
affecting both the peripheral and central nervous systems.
Let's find out about the neurological complications of COVID-19!
Arguably, the most common benign neuro-related complications of COVID-19 documented in the scientific literature are loss of smell and/or taste
.
While coronaviruses are known to typically cause loss of smell and/or taste, these symptoms were not initially thought to be a major feature of
SARS-CoV-2 infection.
About 40% and 38% of people with confirmed COVID-19 have been reported to have altered
sense of smell and taste to varying degrees.
Most people with SARS-CoV-2 experience a brief loss of smell/taste, with an average of 7 days
after symptom onset.
Studies have also shown that some patients experience loss of smell/taste for a long time (weeks or months), and some patients even lose their sense of smell/taste for a long time and have not returned to normal
.
Another neurological symptom of COVID-19 is headache, and while this usually resolves within a week, some people experience long-term headaches (such as migraines)
after the initial infection.
One of the more common serious neurological complications in people with COVID-19 is cerebrovascular events, which can severely affect neurological function
.
Studies have shown that the incidence of cerebrovascular accidents (CVAs) in COVID-positive patients is as high as 6%.
Arterial CVAs can be broadly classified as ischaemic stroke or haemorrhagic stroke, and are most common in older adults and people
with associated risk factors such as overweight/obesity, hypertension, hyperlipidemia, and diabetes.
People with COVID-19 who develop stroke are younger, more male, and have more severe neurological impairment
than those without COVID-19.
For patients with COVID-19 who are intubated and/or heavily sedated, it is more difficult to tell
when CVAs occur.
Patients with COVID-19 admitted to hospital, especially those admitted to the ICU
, are at significantly higher risk of developing CVAs.
COVID-19 can also lead to intravenous complications, one of the more serious of which is cerebral venous sinus thrombosis (CVST).
Severe CVST blocks blood flow from the brain, leading to the risk of
hemorrhagic transformation.
CVST usually affects young people, and symptoms may include headaches, blurred vision, seizures, and loss of
consciousness.
With or without intubation, a clinical sign of suspected CVST is papilledema, as CVST can cause intracranial hypertension
.
The documented occurrence of such complications in young COVID-19 patients without cardiovascular risk factors highlights the ability of SARS-CoV-2 to affect any population of any age group, regardless of
baseline clinical status.
COVID-19 can cause partial neurological inflammation, including meningitis and parenchymal enceparenchitis
.
Patients with COVID with underlying comorbidities or receiving immunosuppressive therapies (e.
g.
, steroids) have been shown to be at increased risk of developing opportunistic infections, including neuroinflammatory diseases such as bacterial, fungal, or viral meningoencephalitis
.
Patients with isolated meningitis may present with fever, headache, and nuchal rigidity
.
Encephalitis is usually more severe and can progress to encephalopathy, which affects the structure/function of the brain, with symptoms suggestive of severe brain damage
.
In addition, patients may experience severe seizures
due to disruption of neural activity in the brain.
The overall clinical outcome of patients with neuroinflammatory disease with COVID-19 depends on a variety of factors
.
Some patients may recover completely, while others experience long-term neurological problems
.
Peripheral nervous system infection with SARS-CoV-2 can also cause some symptoms, including peripheral movement, structural and functional impairment of sensory nerves, specifically manifested as taste disorders, decreased libido, facial paralysis, fatigue, and distal limb paresthesias and glove-sock hypoesthesia
.
Studies have shown that the prevalence of peripheral neuropathy is higher in COVID-19 patients than in non-COVID-19 patients
.
One aspect of SARS-CoV-2 that is not yet fully understood is the long-term sequelae it can cause to different systems in the body, and while COVID-19 mainly affects the respiratory and cardiovascular systems, neurological complications are not uncommon
.
There are many different types of neurological complications that can occur in people with COVID-19, some of which precede respiratory symptoms and others that are the patient's only symptom, so clinicians need to be highly aware of them for prompt treatment and prevention
.
Resources:
1.
Dale L.
Neurological Complications of COVID-19: A Review of the Literature.
Cureus.
2022 Aug 3; 14(8):e27633.
doi: 10.
7759/cureus.
27633.
2.
LIU Jun, QIU Jun, et al.
Research progress on the impact of new coronavirus on nervous system[J].
Medical Theory & Practice,2022,35(19):3266-3268+3275.
)
3.
XU Zhenhua,LIU Shuirong,JIANG Xiaoxia.
Progress on the impact of novel coronavirus on nervous system[J].
Military Medicine,2021,45(12):950-954+960.
)
