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Review
. 2021 Jun 28;21(9):44.
doi: 10.1007/s11910-021-01130-1.

The Neurological Manifestations of Post-Acute Sequelae of SARS-CoV-2 infection

Narges Moghimi  1 , Mario Di Napoli  2 , José Biller  3 , James E Siegler  4 , Rahul Shekhar  5 , Louise D McCullough  6 , Michelle S Harkins  5 , Emily Hong  1 , Danielle A Alaouieh  1 , Gelsomina Mansueto  7 , Afshin A Divani  8
Affiliations
Review

The Neurological Manifestations of Post-Acute Sequelae of SARS-CoV-2 infection

Narges Moghimi et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global health challenge. This review aims to summarize the incidence, risk factors, possible pathophysiology, and proposed management of neurological manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC) or neuro-PASC based on the published literature.

Recent findings: The National Institutes of Health has noted that PASC is a multi-organ disorder ranging from mild symptoms to an incapacitating state that can last for weeks or longer following recovery from initial infection with SARS-CoV-2. Various pathophysiological mechanisms have been proposed as the culprit for the development of PASC. These include, but are not limited to, direct or indirect invasion of the virus into the brain, immune dysregulation, hormonal disturbances, elevated cytokine levels due to immune reaction leading to chronic inflammation, direct tissue damage to other organs, and persistent low-grade infection. A multidisciplinary approach for the treatment of neuro-PASC will be required to diagnose and address these symptoms. Tailored rehabilitation and novel cognitive therapy protocols are as important as pharmacological treatments to treat neuro-PASC effectively. With recognizing the growing numbers of COVID-19 patients suffering from neuro-PASC, there is an urgent need to identify affected individuals early to provide the most appropriate and efficient treatments. Awareness among the general population and health care professionals about PASC is rising, and more efforts are needed to understand and treat this new emerging challenge. In this review, we summarize the relevant scientific literature about neuro-PASC.

Keywords: COVID-19; Chronic fatigue syndrome; Long COVID; Myalgic encephalomyelitis; PASC; Post-Acute Sequelae of SARS-CoV-2 infection; Post-COVID syndrome; SARS-CoV-2.

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Conflict of interest statement

Narges Moghimi, Mario Di Napoli, José Biller, James E. Siegler, Rahul Shekhar, Louise D McCullough, Michelle S Harkins, Emily Hong, Danielle A Alaouieh, Gelsomina Mansueto, and Afshin A. Divani each declare no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Organ systems affected by PASC (the figure generated using biorender.com)
Fig. 2
Fig. 2
Proposed neuro-PASC diagnostic criteria
Fig. 3
Fig. 3
A proposed post-COVID care pathway for patients with suspected neuro-PASC
See this image and copyright information in PMC

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References

    1. Leung TYM, Chan AYL, Chan EW, Chan VKY, Chui CSL, Cowling BJ, Gao L, Ge MQ, Hung IFN, Ip MSM, Ip P, Lau KK, Lau CS, Lau LKW, Leung WK, Li X, Luo H, Man KKC, Ng VWS, Siu CW, Wan EYF, Wing YK, Wong CSM, Wong KHT, Wong ICK. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020;9(1):2190–2199. doi: 10.1080/22221751.2020.1825914. - DOI - PMC - PubMed
    1. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, Cook JR, Nordvig AS, Shalev D, Sehrawat TS, Ahluwalia N, Bikdeli B, Dietz D, der-Nigoghossian C, Liyanage-Don N, Rosner GF, Bernstein EJ, Mohan S, Beckley AA, Seres DS, Choueiri TK, Uriel N, Ausiello JC, Accili D, Freedberg DE, Baldwin M, Schwartz A, Brodie D, Garcia CK, Elkind MSV, Connors JM, Bilezikian JP, Landry DW, Wan EY. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601–615. doi: 10.1038/s41591-021-01283-z. - DOI - PMC - PubMed
    1. Mansueto G. COVID-19: brief check through the pathologist’s eye (autopsy archive) Pathol Res Pract. 2020;216(11):153195. doi: 10.1016/j.prp.2020.153195. - DOI - PMC - PubMed
    1. Arnold DT, Hamilton FW, Milne A, Morley AJ, Viner J, Attwood M, et al. Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. Thorax. 2020. 10.1136/thoraxjnl-2020-216,086. - PMC - PubMed
    1. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol. 2021;93(2):1013–1022. doi: 10.1002/jmv.26368. - DOI - PubMed