Neurological features of COVID-19 and their treatment: a review

Abstract

Severe acute respiratory syndrome-correlated new coronavirus (SARS-Cov-2) infection may result in neurological signs and symptoms through different mechanisms. Although direct infection of the central nervous system is uncertain or very rare and the para-infectious complications (e.g. inflammatory neuropathies) are rare, delirium and septic encephalopathy are common in severely ill patients. Smell dysfunction and headache are very common in mild cases, especially in younger people and females. Muscle pain is common in both mild and severe cases, and in the most compromised patients, it is accompanied by increased creatine kinase levels and by a likely true myopathic damage. Ischemic stroke has been reported as a possible complication of the hypercoagulability associated with severe SARS-Cov-2 infection, but further studies are needed. Most of the neurological manifestations may occur early in the illness. Therefore, during the pandemic period, neurologists need to be involved, alert, and prepared. Neurological practice will not be the same until a vaccine is available.

Keywords: COVID-19; CPK; Guillain-Barré syndrome; Sars-Cov-2; anosmia; coronavirus; myopathy; myositis; stroke.

Figure 1

Minor stroke in a COVID-19-positive subject. Our patient presented at 70 years with transitory sensory and motor disturbances on the left side of the body (~6 hours). His past medical history was remarkable for hypertension, type 2 diabetes, chronic renal disease, dyslipidemia, and ischemic heart disease with a myocardial infarction. He had an implantable cardioverter-defibrillator and pacemaker (not MRI compatible). He was a smoker. The day before he was discharged from the pneumological unit of our hospital, where he had been hospitalized for 27 days because of COVID-19-related bilateral pneumonia. SARS-Cov-2 RNA was still detectable in his nasopharyngeal specimens by reverse-transcription polymerase chain reaction. Brain CT (left) and angioCT (right) revealed a thrombus in the right cerebral posterior artery (arrows). When he was evaluated, the disturbances were resolved and the neurological examination was normal. Therefore, there were not any criteria for systemic thrombolysis or mechanical thrombectomy, and he was treated with standard medical therapy.

Figure 2

The most typical neurological features associated with mild (left) and severe (right) coronavirus disease 2019.