Neurological complications in patient with COVID-19
Abstract
The article presents an analysis of the literature, as well as our own research on neurological complications in patients with COVID-19. SARS-CoV-2 virus (further – COVID-19) damages the respiratory tract and lungs, leads to the development of not only acute heart, kidney, multiple organ failure, but also accompanied by symptoms of nervous system damage. The most common and severe among the neurological complications of COVID-19 are cerebrovascular diseases, acute necrotic encephalopathy, encephalitis, encephalomyelitis, hypoxic encephalopathy, Hyena-Barre syndrome. Studies have shown that patients with COVID-19 have an average risk of stroke of 5-8%. All subtypes of stroke can occur as a result of infection. Recommendations for the management of stroke patients with COVID-19 are presented. Lesions of the peripheral nervous system are manifested in the form of hyposmia, anosmia, Hyena-Barre syndrome. An association between the severity of the viral infection and the frequency and severity of neurological disorders has been established. The results of own researches of 42 patients in the postcovid period are presented. It was shown that 95.2% of patients had neurocognitive disorders of varying severity, asthenic syndrome (increased fatigue on the MF1-20 scale 13.0 points), sleep disorders, dizziness, vestibular disorders, cephalic syndrome, hyposmia in 19% of patients. The subjects also had anxiety and depressive disorders according to the HADS scale. Ischemic stroke and transient ischemic attacks (TIA) have been reported in some patients. Pathogenetically justified the feasibility of drugs that affect endothelial function.
Downloads
References
Kleine-Weber H., Schroeder S. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and Is blocked by a clinically proven protease inhibitor. Cell. –2020. Vol. 181, pp. 271-280. https://doi.org/10.1016/j.cell.2020.02.052
World Health Organization. 11 March 2020. [Electronic resource] Resource access: httph://www.int/ru/dg/speeches/ detail/who-director-general-s-opening-remarks-at-the-media-briefingon-covid-19.
Wang X.L., Iwanami J., Min L.J. [et al.] Deficiency of angiotensin-converting enzyme 2 causes deterioration of cognitive function. NPJ Aging Mech Dis. 2016. Vol. 2, pp. 16-24. https://doi.org/10.1038/npjamd.2016.24
Kehoe P.G., Wong S., Al Mulhim N. [et al.] Angiotensinconverting enzyme 2 is reduced in Alzheimer’s disease in association with increasing amyloid-β and tau pathology. Alzheimers Res Ther. 2016. Vol. 8(1), pp. 50. https://doi.org/10.1186/s13195-016-0217-7
Li Y., Li H., Fan R. [et al.] Coronavirus infections in the central nervous system and respiratory tract show distinct features in hospitalized children // Intervirology. 2016. Vol. 59(3), pp. 163–169. https://doi.org/10.1159/000453066
Niu J., Shen L., Huang B. [et al.] Non-invasive bioluminescence imaging of HCoV-OC43 infection and therapy in the central nervous system of live mice // Antiviral Res. 2020. Vol.173, pp. 104646. https://doi.org/10.1016/j.antiviral.2019.104646
Chan J.F., Chan K.H., Choi G.K. [et al.] Differentialcell line susceptibility to the emerging novel human betacoronavirus 2c EMC/2012: implications for disease pathogenesis and clinical manifestation. J Infect Dis. 2013. Vol. 207(11), pp. 1743–1752. https://doi.org/10.1093/infdis/jit123
Desforges M., Miletti T.C., Gagnon M. [et al.] Activation of human monocytes after infection by human coronavirus 229E. Virus Res. 2007. Vol. 130(1–2), pp. 228–240.
Li J., Gao J., Xu Y.P. [et al.] Expression of severe acute respiratory syndrome coronavirus receptors, ACE2 and CD209L in different organ derived microvascular endothelial cells. Zhonghua Yi Xue Za Zhi. 2007. Vol. 87(12), pp. 833–837.
Tetyana P. Buzhdygana, Brandon J. DeOrec, Abigail Baldwin-Leclairc [et al.] The SARS-CoV-2 spike protein alters barrier function in 2D static and 3D microfluidic in-vitro models of the human blood–brain barrier. Neurobiology of Disease. 2020. Vol. 146. [Electronic resource] Access mode: https://www.sciencedaily.com/releases/2020/10/201029141941.htm
Hirano N, et al. Neurotropic virus tracing suggests a membranous-coating-mediated mechanism for transsynaptic communication. J. Comp. Neurol. 2013. Vol. 521(1), pp. 203–212.
Lodigiani C., Iapichino G., Carenzo L. [et al.] Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020. Vol. 191, pp. 9–14. https://doi.org/10.1016%2Fj.thromres.2020.04.024
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;e201127. https://doi.org/10.1001/jamaneurol.2020.1127
Mai N. Nguyen-Huynh, Xian Nan Tang, David R. Vinson [et al.] Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic. Stroke (IF 7.190) Pub. Date: 2020-08-07. https://doi.org/10.1161/strokeaha.120.031099
Li Y., Li M., Wang M. [et al.] Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020. Vol. 5(3), pp. 279-284. https://doi.org/10.1136/svn-2020-000431.
Zhang Y, Xiao M, Zhang S. [et al.] Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020. 382(17):e38. https://doi.org/10.1056/NEJMc2007575
Moshayedi P., Ryan T.E., Mejia L.P. [et al.] Triage of acute ischemic stroke in confirmed COVID-19: large vessel occlusion associated with coronavirus infection. Front Neurol. 2020. Vol. 11, pp. 353. https://doi.org/10.3389/fneur.2020.00353
Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral haemorrhage: causative or coincidental? New Microbes New Infect. 2020. Vol. 35:100669. https://doi.org/10.1016/j.nmni.2020.100669
Helms J., Kremer S., Merdji H. [et al.] Neurologic features in severe SARS-CoV-2 infection. N. Engl. J. Med. 2020. Vol. 382(23), pp. 2268–2270. https://doi.org/10.1056/NEJMc2008597
Trishchinskaya MA, Kononov OE, Belskaya IV Pathogenetically substantiated prevention of cerebrovascular diseases in patients with coronavirus infection // Int. Neur. J. 2020. Vol. 16, no. 7, pp. 28-36. [in Ukr.]
Qureshi A.I., Abd-Allah F., Al-Senani F. [et al.] Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel. Int. J. Stroke. 2020. Vol. 15(5), pp. 540-554. https://doi.org/10.1177/1747493020923234.
Luneva I.E., Polishchuk R.V., Chernobaeva L.S. [et al.] Acute necrotizing encephalitis associated with influenza virus in adults. J. of Neurol. and psychiatry about S.S. Korsakov. 2020. Vol. 120 (4), pp. 101-105. [in Russ.] https://doi.org/10.17116/jnevro2019119121100
Poyiadji N., Shahin G., Noujaim D. [et al.] COVID 19-ssociated acute hemorrhagic necrotizing encephalopathy: CT and MRI Features. Radiology. 2020. Vol. 296(2). E119-E120. https://doi.org/10.1148/radiol.2020201187.
Adams J.H., Jennett W.B. Acute necrotizing encephalitis: a problem in diagnosis. J. Neurol. Neurosurg. Psychiatry. 1967. Vol. 30(3), pp. 248-260. https://doi.org/10.1136/jnnp.30.3.248
Koh J.C., Murugasu A., Krishnappa J. [et al.] Favorable outcomes with early interleukin 6 receptor blockade in severe acute necrotizing encephalopathy of childhood. Pediatr. Neurol. 2019. Vol. 98, pp. 80-84. https://doi.org/10.1016/j.pediatrneurol.2019.04.009
Lin Y.Y., Lee K.Y., Ro L.S. [et al.] Clinical and cytokine profile of adult acute necrotizing encephalopathy. Biomed J. 2019. Vol. 42(3). pp. 178-186. https://doi.org/10.1016/j.bj.2019.01.008
Filatov A, Sharma P, Hindi F. [et al.] Neurological complications of coronavirus disease (COVID-19): Encephalopathy. Cureus. 2020. Vol. 12(3):e7352.
Zhou L., Zhang M., Wang J. [et al.] Sars-CoV-2: Underestimated damage to nervous system [published online ahead of print, 2020 Mar 24]. Travel Med. Infect. Dis. 2020, 101642. [Electronic resource] Access mode: https://pubmed.ncbi.nlm.nih.gov/32220634/
Ye M., Ren Y., Lv T. Encephalitis as a clinical manifestation of COVID-19 [published online ahead of print 2020 Apr 10]. Brain Behav Immun. 2020;S0889- 1591(20)30465-7. [Electronic resource] Access mode: https://pubmed.ncbi.nlm.nih.gov/32283294/
Pilotto A., Odolini S., Masciocchi S. [et al.] Steroidresponsive encephalitis in coronavirus disease 2019 [published online ahead of print, 2020 May 17]. Ann Neurol. 2020;10.1002/ana.25783. [Electronic resource] Access mode: https://pubmed.ncbi.nlm.nih.gov/32418288/
Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARSCoronavirus-2. Int. J. Infect. Dis. 2020. Vol. 94, pp. 55–58. https://doi.org/10.1016/j.ijid.2020.03.062
Duong L, Xu P, Liu A. Meningoencephalitis without respiratory failure in a young female patient with COVID-19 infection in Downtown Los Angeles, early April 2020. Brain Behav Immun. 2020. Vol. 87, pp. 33. https://doi.org/10.1016/j.bbi.2020.04.024.
Bernard-Valnet R., Pizzarotti B., Anichini A. [et al.] Two patients with acute meningo-encephalitis concomitant to SARS-CoV-2 infection. Eur. J. Neurol. 2020. Vol. 27(9), e43-e44. https://doi.org/10.1111/ene.14298.
Zhao K., Huang J., Dai D. [et al.] Acute myelitis after SARS-CoV-2 infection: a case report. medRxiv 2020. 2020.03.16.20035105; https://doi.org/10.1101/2020.03.16.20035105
Wu Y., Xu X., Chen Z. [et al.] Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020. Vol. 87, pp. 18–22. https://doi.org/10.1016/j.bbi.2020.03.031.
Chen T., Wu D., Chen H. [et al.] Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020. Vol. 26, pp. 368. https://doi.org/10.1136/bmj.m1091.
Arbour N., Day R., Newcombe J. [et al.] Neuroinvasion by human respiratory coronaviruses. J. Virol. 2000. Vol. 74(19), pp. 8913-8921. https://doi.org/10.1128/jvi.74.19.8913-8921.2000
Talbot P.J., Paquette J.S., Ciurli C. [et al.] Myelin basic protein and human coronavirus 229E cross-reactive T cells in multiple sclerosis. Ann. Neurol. 1996. Vol. 39(2), pp. 233-240. https://doi.org/10.1002/ana.410390213
Gane S.B., Kelly C., Hopkins C. Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome? Rhinology. 2020. Vol. 58(3), pp. 299-301.
https://doi.org/10.4193/Rhin20.114. PMID: 32240279.
Yan C.H., Faraji F., Prajapati D.P. [et al.] Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. Int. Forum Allergy Rhinol. 2020. Vol. 10(7), pp. 806-813. https://doi.org/10.1002/alr.22579
Bagheri S.H., Asghari A.M., Farhadi M. [et al.] Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med. J. Islam. Repub. 2020. Vol. 15 (34), pp. 62. https://doi.org/10.34171/mjiri.34.62
ENT UK. Loss of sense of smell as marker of COVID-19 infection. Accessed March 30, 2020. [Electronic resource]. Access mode: https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf
Xu H., Zhong L., Deng J. [et al.] High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int. J. Oral. Sci. 2020. Vol. 12(1), pp. 8. https://doi.org/10.1038/s41368-020-0074-x
Padroni M., Mastrangelo V., Asioli G.M. [et al.] Guillain-Barré syndrome following COVID-19: new infection, old complication? [published online ahead of print, 2020 Apr 24]. J. Neurol. 2020. Vol. 267(7), pp. 1877-1879. https://doi.org/10.1007/s00415-020-09849-6
Virani A, Rabold E, Hanson T, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection [published online ahead of print, 2020 Apr 18]. IDCases. 2020;20:e00771. [Electronic resource]. Access mode: https://pubmed.ncbi.nlm.nih.gov/32313807/
Camdessanche J.P., Morel J., Pozzetto B. [et al.] COVID-19 may induce Guillain-Barré syndrome. Rev. Neurol. (Paris). 2020. Vol. 176(6), pp. 516–518. https://doi.org/10.1016/j.neurol.2020.04.003
Sedaghat Z., Karimi N. Guillain Barre syndrome associated with COVID-19 infection: A case report. J. Clin. Neurosci. 2020. Vol. 76, pp. 233–235. https://doi.org/10.1016/j.jocn.2020.04.062
Zhao H., Shen D., Zhou H. [et al.] Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020. Vol. 19(5), pp. 383–384. https://doi.org/10.1016/s1474-4422(20)30109-5
Toscano G., Palmerini F., Ravaglia S. [et al.] Guillain-Barré syndrome associated with SARS-CoV-2. N. Engl. J. Med. 2020. Vol. 382(26), pp. 2574–2576. https://doi.org/10.1056/nejmc2009191
Gutiérrez-Ortiz C., Méndez-Guerrero A., Rodrigo-Rey S. [et al.] Miller Fisher syndrome and polyneuritis cranialis in COVID-19 [published online ahead of print, 2020 Apr 17]. Neurology. 2020. Vol. 95(5), pp. e601-e605. https://doi.org/10.1212/WNL.0000000000009619.
Ruan Q., Yang K., Wang W. [et al.] Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020. Vol. 46(5), pp. 846-848. https://doi.org/10.1007/s00134-020-05991-x
Senger D., Erbguth F. Critical illness myopathy and polyneuropathy. Med. Klin Intensivmed Notfmed. 2017. Vol. 112(7), pp. 589-596. https://doi.org/10.1007/s00063-017-0339-0
Baird G.S., Montine T.J. Multiplex immunoassay analysis of cytokines in idiopathic inflammatory myopathy. Arch. Pathol. Lab. Med. 2008. Vol. 132(2), pp. 232- 238. https://doi.org/10.1043/1543-2165(2008)132[232:miaoci]2.0.co;2
Varga Z., Flammer A.J., Steiger P. [et al.] Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020. Vol. 395(2), pp. 1417-1418. https://doi.org/10.1016/s0140-6736(20)30937-5
Zhang W., Zhao Y., Zhang F. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China. Clinical Immunology. 2020, 214:108393. https://doi.org/10.1016/j.clim.2020.108393.
Negrich T.I. The use of edaravon, citicoline and electrolytes and L-arginine in patients with acute cerebral circulatory disorders. NeuroNEWS. 2020. Vol. 9 (120), pp. 12-19. [in Ukr.]
