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Neurologic complications in COVID-19 patient.

Neurologic complications & management of neurologic conditions in a Coronavirus disease 2019 (COVID-19) patient.

 

Neurologic complications & management of neurologic conditions in a Coronavirus disease 2019 (COVID-19) patient.

 

neurologic complications of coronavirus infections does covid cause neurological problems can covid cause neurological problems does covid cause neurological damage covid neurological problems neurologic complications and covid neurological complications after covid neurological problems after coronavirus neurological problems after covid neurologic effects of covid can covid 19 cause encephalopathy can covid 19 cause neurological damage neurological complications from covid-19

Neurologic complications occur in about 50% of hospitalized ptns with 2019 COVID-19. Myalgias, headache, & encephalopathy are usually most common. Other neurologic Sms e.g. dizziness, dysgeusia, or anosmia are less common. However, stroke, movement disorders, motor & sensory deficit, ataxia, & seizures are currently uncommon. It still not certain which, if any, of these neurologic sequelae  are specifically related to COVID-19 infection and which of them reflecting the anticipated co-morbidity and/or the complications observed in critically ill ptns in general. Encephalopathy is commonly seen in critically ill ptns with COVID-19. Generally, traditional toxic-metabolic alterations have been currently implicated. However, if medication-induced, hypoxemia, or other lab profile abnormalities cannot explain the ptn's deterioration, the requested evaluation to rule out other pathology should include neuroimaging with MRI, electroencephalography (EEG), as well as CSF testing.  

 

neurologic complications of coronavirus infections does covid cause neurological problems can covid cause neurological problems does covid cause neurological damage covid neurological problems neurologic complications and covid neurological complications after covid neurological problems after coronavirus neurological problems after covid neurologic effects of covid can covid 19 cause encephalopathy can covid 19 cause neurological damage neurological complications from covid-19

Stroke has been reported with COVID-19 infection in about 1-3 % of hospitalized ptns, with elevated rate in those with a more intense COVID-19 disease. A variety of sub-types can be seen, including ischemic stroke, intracranial hemorrhage, & cerebral venous sinus thrombosis. To be added to the traditional stroke mechanisms, a potential mechanism of ischemic stroke can be correlated to COVID-19 including:

1)    Hypercoagulability state,

2)    Intense inflammation,

3)    Renin-angiotensin-aldosterone system malfunction,

4)    Cardiac dysfunction, &

5)    The sequelae of severe respiratory distress.

The management of ischemic or hemorrhagic stroke in ptns under evaluation or those who’re +ve for COVID-19 infection must follow a similar standard of care as that in ptns with no COVID-19 disease, with necessary measures related to infection control. Some cases of Guillain-Barre syndrome (GBS) & related syndromes have been reported in ptns with COVID-19 infection. Generally, the assessment & management of such ptns is simulating that in those without COVID-19 infection.  

 

However, acute disseminated encephalomyelitis, meningoencephalitis, generalized myoclonus, & posterior reversible encephalomyelopathy are rarely reported with COVID-19 infection. At present there’s no evidence suggesting that ptns with neurologic disease who’re treated with immunosuppressive medications are at a higher risk of COVID-19 infection, and such therapy should be maintained in uninfected ptns during the pandemic. If ptns on such medications become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an individualized approach considering the anticipated risk that’s usually accompanying these specific type of therapy, severity of the underlying neurologic disease and the intensity of COVID-19 illness. Ptns with a history of CVS disease, including stroke, seem to be at risk of worse outcome due to COVID-19: this likely applies to other ptns with debilitating neurological illness. Such ptns should be particulrly advised to be adherent to the necessary preventive precautions.  

 

REFERENCES

1.    World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. http://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020 (Accessed on February 12, 2020).

2.    World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance (Accessed on February 14, 2020).

3.    Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China. Information for Healthcare Professionals. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html (Accessed on February 14, 2020).

4.    National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. https://covid19treatmentguidelines.nih.gov/ (Accessed on October 26, 2020).

5.    Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020; 77:683.

6.    Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med 2020; 382:2268.

7.    Montalvan V, Lee J, Bueso T, et al. Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clin Neurol Neurosurg 2020; 194:105921.

8.    Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, et al. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology 2020; 95:e1060.

9.    Koralnik IJ, Tyler KL. COVID-19: A Global Threat to the Nervous System. Ann Neurol 2020; 88:1.

10.  Xiong W, Mu J, Guo J, et al. New onset neurologic events in people with COVID-19 in 3 regions in China. Neurology 2020; 95:e1479.

11.  Herman C, Mayer K, Sarwal A. Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19. Neurology 2020; 95:77.

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