COVID-19 Neurologic Complications: Difference between revisions
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==Pathophysiology of the Complications in the Nervous System== | ==Pathophysiology of the Complications in the Nervous System== | ||
The spectrum of neurological manifestations have been seen throughout the COVID-19 pandemic. These manifestations range from headache to encephalitis.<ref name="pmid32275288">{{cite journal| author=Mao L, Jin H, Wang M, Hu Y, Chen S, He Q | display-authors=etal| title=Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. | journal=JAMA Neurol | year= 2020 | volume= | issue= | pages= | pmid=32275288 | doi=10.1001/jamaneurol.2020.1127 | pmc=7149362 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32275288 }}</ref> Here raises a question that how does the SARS-CoV-2 virus reaches the mileu of brain? Severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory Syndrome (MERS-CoV) have caused many neurological manifestations in the previous pandemics of 2003 and 2012, respectively, as the nucleic acid of SARS-CoV and MERS-CoV was found in cerebrospinal fluid<ref name="pmid25303830">{{cite journal| author=Saad M, Omrani AS, Baig K, Bahloul A, Elzein F, Matin MA | display-authors=etal| title=Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia. | journal=Int J Infect Dis | year= 2014 | volume= 29 | issue= | pages= 301-6 | pmid=25303830 | doi=10.1016/j.ijid.2014.09.003 | pmc=7110769 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25303830 }}</ref> and later the nucleic acid was found in autopsy of brain.<ref name="pmid31133031">{{cite journal| author=Schoeman D, Fielding BC| title=Coronavirus envelope protein: current knowledge. | journal=Virol J | year= 2019 | volume= 16 | issue= 1 | pages= 69 | pmid=31133031 | doi=10.1186/s12985-019-1182-0 | pmc=6537279 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31133031 }}</ref> Genetically, SARS-CoV-2 is 79% identical to SARS-CoV and 50% identical to MERS-CoV.<ref name="pmid32007145">{{cite journal| author=Lu R, Zhao X, Li J, Niu P, Yang B, Wu H | display-authors=etal| title=Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. | journal=Lancet | year= 2020 | volume= 395 | issue= 10224 | pages= 565-574 | pmid=32007145 | doi=10.1016/S0140-6736(20)30251-8 | pmc=7159086 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32007145 }}</ref> Due to this structural homology of SARS-CoV-2 with SARS-CoV and MERS-CoV it can be proposed that SARS-CoV-2 is neurotropic and uses the same mechanism of pathogenecity as SARS-CoV and MERS-CoV. | |||
==Mechanism of targetting the Nervous System== | ==Mechanism of targetting the Nervous System== | ||
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*'''Pathophysiology''' | *'''Pathophysiology''' | ||
**Guillain–Barre syndrome causes immune-mediated damage to the peripheral nerves that usually follows gastrointestinal or respiratory illnesses. The polyneuropathy in Guillain–Barre syndrome is believed to be due to cross-immunity against epitopes of peripheral nerve components that it shares with the epitopes on the cell surface of bacteria that produces an antecedent infection | **Guillain–Barre syndrome causes immune-mediated damage to the peripheral nerves that usually follows gastrointestinal or respiratory illnesses. The polyneuropathy in Guillain–Barre syndrome is believed to be due to cross-immunity against epitopes of peripheral nerve components that it shares with the epitopes on the cell surface of bacteria that produces an antecedent infection . Most common antecedent infections are Campylobacter jejuni ,Zika virus and influenza virus.<br/> | ||
**The mechanism of Guillain–Barre syndrome in patients infected with COVID-19 is not fully understood yet. | **The mechanism of Guillain–Barre syndrome in patients infected with COVID-19 is not fully understood yet. | ||
**COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it initiates immune-mediated processes | **COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it initiates immune-mediated processes.'Molecular mimicry' as a mechanism of autoimmune disorder plays an important role in formation of Guillain–Barre syndrome. It is not yet clear whether COVID-19 induces the production of antibodies against specific gangliosides that usually appear with certain forms of Guillain–Barre syndrome<ref name="pmid32312628">{{cite journal |vauthors=Sedaghat Z, Karimi N |title=Guillain Barre syndrome associated with COVID-19 infection: A case report |journal=J Clin Neurosci |volume=76 |issue= |pages=233–235 |date=June 2020 |pmid=32312628 |pmc=7158817 |doi=10.1016/j.jocn.2020.04.062 |url=}}</ref>.<br/> In the future further investigations should be conducted about the mechanism of GBS in patients with COVID-19 for better understanding. | ||
*'''Epidemiology and Demographics''' | *'''Epidemiology and Demographics''' | ||
**Five cases of Guillain-Barre syndrome (GBS) in patients with COVID-19 has been reported in three hospitals in northern Italy from February 28 through March 21, 2020. | **Five cases of Guillain-Barre syndrome (GBS) in patients with COVID-19 has been reported in three hospitals in northern Italy from February 28 through March 21, 2020.. Four of these patients had a positive nasopharyngeal swab for SARS-CoV-2 at the onset of the neurologic syndrome, and one had a negative nasopharyngeal swab and negative bronchoalveolar lavage but subsequently he developed a positive serologic test for the virus.<br/> | ||
**The first official case of Guillain-Barre syndrome (GBS) associated in patients with COVID-19 in the United States has been reported by neurologists from Allegheny General Hospital in Pittsburgh, Pennsylvania in June,2020. | **The first official case of Guillain-Barre syndrome (GBS) associated in patients with COVID-19 in the United States has been reported by neurologists from Allegheny General Hospital in Pittsburgh, Pennsylvania in June,2020..The patient was a 54-year-old man who was transferred to Allegheny General Hospital after developing ascending limb weakness and numbness that followed symptoms of a respiratory infection.The man reported that his wife was tested positive for COVID-19 infection and that his symptoms started soon after her illness. Later he also tested positive for COVID-19. | ||
**Another case of Guillain–Barre syndrome with COVID-19 has been reported in Iran | **Another case of Guillain–Barre syndrome with COVID-19 has been reported in Iran. | ||
Revision as of 03:46, 25 June 2020
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COVID-19 Neurologic Complications On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Rinky Agnes Botleroo, M.B.B.S., Wajeeha Aiman, M.D.[2], Parul Pahal, M.B.B.S[3]
Overview
Pathophysiology of the Complications in the Nervous System
The spectrum of neurological manifestations have been seen throughout the COVID-19 pandemic. These manifestations range from headache to encephalitis.[1] Here raises a question that how does the SARS-CoV-2 virus reaches the mileu of brain? Severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory Syndrome (MERS-CoV) have caused many neurological manifestations in the previous pandemics of 2003 and 2012, respectively, as the nucleic acid of SARS-CoV and MERS-CoV was found in cerebrospinal fluid[2] and later the nucleic acid was found in autopsy of brain.[3] Genetically, SARS-CoV-2 is 79% identical to SARS-CoV and 50% identical to MERS-CoV.[4] Due to this structural homology of SARS-CoV-2 with SARS-CoV and MERS-CoV it can be proposed that SARS-CoV-2 is neurotropic and uses the same mechanism of pathogenecity as SARS-CoV and MERS-CoV.
Mechanism of targetting the Nervous System
Complications in the Central Nervous System
Headache
- Pathophysiology
- The exact pathogenesis of headache in COVID 19 patients is not fully understood.
- It is thought that headache is the result of:
- Cytokine release
- There is higher concentration on IL-6 and INF-gamma in patients infected with SARS/ CoV2.
- Cytokines can disrupt blood brain barrier and cause tissue injury and cerebral edema.
- Direct invasion
- Metabolic disturbances
- Inflammation
- Dehydration
- Hypoxia
- Cytokine release
- Natural history
- Sign and symptoms
- Treatment
Cerebrovascular Accident/Stroke
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Acute Encephalitis
- Pathophysiology
- The pa
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Viral Meningitis
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Epileptic Seizures
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Encephalopathy
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Complications in the Peripheral Nervous system
Guillain-Barre syndrome
- Pathophysiology
- Guillain–Barre syndrome causes immune-mediated damage to the peripheral nerves that usually follows gastrointestinal or respiratory illnesses. The polyneuropathy in Guillain–Barre syndrome is believed to be due to cross-immunity against epitopes of peripheral nerve components that it shares with the epitopes on the cell surface of bacteria that produces an antecedent infection . Most common antecedent infections are Campylobacter jejuni ,Zika virus and influenza virus.
- The mechanism of Guillain–Barre syndrome in patients infected with COVID-19 is not fully understood yet.
- COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it initiates immune-mediated processes.'Molecular mimicry' as a mechanism of autoimmune disorder plays an important role in formation of Guillain–Barre syndrome. It is not yet clear whether COVID-19 induces the production of antibodies against specific gangliosides that usually appear with certain forms of Guillain–Barre syndrome[5].
In the future further investigations should be conducted about the mechanism of GBS in patients with COVID-19 for better understanding.
- Guillain–Barre syndrome causes immune-mediated damage to the peripheral nerves that usually follows gastrointestinal or respiratory illnesses. The polyneuropathy in Guillain–Barre syndrome is believed to be due to cross-immunity against epitopes of peripheral nerve components that it shares with the epitopes on the cell surface of bacteria that produces an antecedent infection . Most common antecedent infections are Campylobacter jejuni ,Zika virus and influenza virus.
- Epidemiology and Demographics
- Five cases of Guillain-Barre syndrome (GBS) in patients with COVID-19 has been reported in three hospitals in northern Italy from February 28 through March 21, 2020.. Four of these patients had a positive nasopharyngeal swab for SARS-CoV-2 at the onset of the neurologic syndrome, and one had a negative nasopharyngeal swab and negative bronchoalveolar lavage but subsequently he developed a positive serologic test for the virus.
- The first official case of Guillain-Barre syndrome (GBS) associated in patients with COVID-19 in the United States has been reported by neurologists from Allegheny General Hospital in Pittsburgh, Pennsylvania in June,2020..The patient was a 54-year-old man who was transferred to Allegheny General Hospital after developing ascending limb weakness and numbness that followed symptoms of a respiratory infection.The man reported that his wife was tested positive for COVID-19 infection and that his symptoms started soon after her illness. Later he also tested positive for COVID-19.
- Another case of Guillain–Barre syndrome with COVID-19 has been reported in Iran.
- Five cases of Guillain-Barre syndrome (GBS) in patients with COVID-19 has been reported in three hospitals in northern Italy from February 28 through March 21, 2020.. Four of these patients had a positive nasopharyngeal swab for SARS-CoV-2 at the onset of the neurologic syndrome, and one had a negative nasopharyngeal swab and negative bronchoalveolar lavage but subsequently he developed a positive serologic test for the virus.
- Sign and symptoms
- Diagnosis
- Treatment
Anosmia
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Acute Myelitis
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Miller Fischer Sydrome
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Polyneuritis Cranialis
- Pathophysiology
- Natural history
- Sign and symptoms
- Diagnosis
- Treatment
Complications due to medication interaction
1. Statin induced myotoxicity
- Myalgia, myopathies, rhabdomyolysis
2. 2nd and 3rd degree atrioventricular block
- Lopinavir/ Ritonavir (Kaltera) (400 mg/100 mg)
3. Prolong QTc interval
- Chloroquine/Hydroxychloroquine
4. Myelotoxicity
- Ribavirin
5. Prolonged PR interval
- Atazanavir
6. Myelosuppression
7.
References
- ↑ Mao L, Jin H, Wang M, Hu Y, Chen S, He Q; et al. (2020). "Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China". JAMA Neurol. doi:10.1001/jamaneurol.2020.1127. PMC 7149362 Check
|pmc=value (help). PMID 32275288 Check|pmid=value (help). - ↑ Saad M, Omrani AS, Baig K, Bahloul A, Elzein F, Matin MA; et al. (2014). "Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia". Int J Infect Dis. 29: 301–6. doi:10.1016/j.ijid.2014.09.003. PMC 7110769 Check
|pmc=value (help). PMID 25303830. - ↑ Schoeman D, Fielding BC (2019). "Coronavirus envelope protein: current knowledge". Virol J. 16 (1): 69. doi:10.1186/s12985-019-1182-0. PMC 6537279 Check
|pmc=value (help). PMID 31133031. - ↑ Lu R, Zhao X, Li J, Niu P, Yang B, Wu H; et al. (2020). "Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding". Lancet. 395 (10224): 565–574. doi:10.1016/S0140-6736(20)30251-8. PMC 7159086 Check
|pmc=value (help). PMID 32007145 Check|pmid=value (help). - ↑ Sedaghat Z, Karimi N (June 2020). "Guillain Barre syndrome associated with COVID-19 infection: A case report". J Clin Neurosci. 76: 233–235. doi:10.1016/j.jocn.2020.04.062. PMC 7158817 Check
|pmc=value (help). PMID 32312628 Check|pmid=value (help).