COVID-19 Neurologic Complications
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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], Template:PP
Overview
Pathophysiology of the Complications in the Nervous System
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 [1]. 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[2][3].'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[3].
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 [1]. 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.[4]. 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.[5].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[6].
- 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.[4]. 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
- ↑ Gupta A, Paliwal VK, Garg RK (July 2020). "Is COVID-19-related Guillain-Barré syndrome different?". Brain Behav. Immun. 87: 177–178. doi:10.1016/j.bbi.2020.05.051. PMC 7239011 Check
|pmc=value (help). PMID 32445789 Check|pmid=value (help). - ↑ Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (February 2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. PMC 7159299 Check
|pmc=value (help). PMID 31986264. - ↑ 3.0 3.1 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). - ↑ Toscano, Gianpaolo; Palmerini, Francesco; Ravaglia, Sabrina; Ruiz, Luigi; Invernizzi, Paolo; Cuzzoni, M..Giovanna; Franciotta, Diego; Baldanti, Fausto; Daturi, Rossana; Postorino, Paolo; Cavallini, Anna; Micieli, Giuseppe (2020). "Guillain–Barré Syndrome Associated with SARS-CoV-2". New England Journal of Medicine. 382 (26): 2574–2576. doi:10.1056/NEJMc2009191. ISSN 0028-4793.
- ↑ Rana, Sandeep; Lima, Arthur A.; Chandra, Rahul; Valeriano, James; Desai, Troy; Freiberg, William; Small, George (2020). "Novel Coronavirus (COVID-19)-Associated Guillain–Barré Syndrome". Journal of Clinical Neuromuscular Disease. 21 (4): 240–242. doi:10.1097/CND.0000000000000309. ISSN 1522-0443.
- ↑ "Frontiers | Neurological Manifestations of COVID-19 (SARS-CoV-2): A Review | Neurology".