Neurologic complications in 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.

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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.