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