An overview of the neurological aspects in COVID-19 infection

Abstract

The Crown-shaped, severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) triggered the globally fatal illness of Coronavirus disease-2019 (COVID-19). This infection is known to be initially reported in bats and has been causing major respiratory challenges. The primary symptoms of COVID-19 include fever, fatigue and dry cough. As progressed the complications may lead to acute respiratory distress syndrome (ADRS), arrhythmia and shock. This review illustrates the neurological and neuropsychiatric impairments due to COVID-19 infection. The SARS-CoV-2 virus enters via the hematogenous or neural route, spreads to the Central Nervous System (CNS), causing a blood-brain barrier (BBB) dysfunction. Recent scientific articles have reported that SARS-CoV-2 causes several neurological issues such as encephalitis, seizures, acute stroke, delirium, meningoencephalitis and Guillain-Barré Syndrome (GBS). As a long-term effect of this disease certain neuropsychiatric conditions are witnessed such as depression and anxiety. Invasion into followed by degeneration takes place causing an uncontrolled immune response. Transcription factors like NF-κB (nuclear factor kappa light chain enhancer of activated B cells), which modulate genes responsible for inflammatory response gets over expressed. Nrf2 (nuclear factor erythroid 2- related factor 2) counterpoises the inflammation by antioxidant response towards COVID-19 infection. Like every other infection, the severity of this infection leads to deterioration of major organ systems and even leads to death. By the columns of this review, we elaborate on the neurological aspects of this life-threatening infection.

Keywords: ACE2; COVID-19; Central nervous system; Neurological disorders; Neuropsychiatric disorders; SARS-CoV-2; TMPRESS2.

Graphical abstract

Fig. 1

Neurological and neuropsychiatric manifestations due to COVID-19 affecting different regions of the brain. The frontal lobe is affected by many neurological abnormalities such as seizures, encephalitis, obsessive-compulsive disorder, psychosis, insomnia, encephalopathy. Disorders like delirium affect the parietal, occipital as well as the temporal lobe. The temporal lobe is also affected by seizures, encephalitis, encephalopathy and respiratory dysfunction. Neuropsychiatric disorders such as pain disorders and anxiety affect the amygdala. Post-traumatic stress disorder affects the hippocampus as well as the amygdala. Guillain-Barré syndrome affects the peripheral nervous system and the spinal cord region.