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 Table of Contents  
SHORT COMMUNICATION
Year : 2022  |  Volume : 7  |  Issue : 3  |  Page : 76-79

Coronavirus disease 2019 infection and neurological manifestations: Points to ponder


1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission25-Apr-2022
Date of Decision20-Jun-2022
Date of Acceptance27-Jul-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ed.ed_11_22

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  Abstract 


The coronavirus disease 2019 (COVID-19) pandemic has changed the dynamics of health care once for all, and we have to continue to mount an unprecedented response to eventually defeat the novel virus pandemic. A wide range of neurological manifestations have been reported among pediatric and adult patients with COVID-19 infection both during and after the patient has recovered from the illness. In terms of preexisting neurological conditions, people with these illnesses are not only vulnerable to acquire the novel viral infection, but at the same time are prone to experience an exacerbation of their preexisting illnesses, and also have poor treatment outcomes, including death. To conclude, a wide range of acute and postacute neurological manifestations have been attributed to the COVID-19 infection worldwide. This calls for the need to create awareness among health-care professionals about neurological symptoms and complications in the post-COVID period.

Keywords: Coronavirus disease 2019 infection, neurology, World Health Organization


How to cite this article:
Shrivastava SR, Shrivastava PS. Coronavirus disease 2019 infection and neurological manifestations: Points to ponder. Environ Dis 2022;7:76-9

How to cite this URL:
Shrivastava SR, Shrivastava PS. Coronavirus disease 2019 infection and neurological manifestations: Points to ponder. Environ Dis [serial online] 2022 [cited 2022 Dec 10];7:76-9. Available from: http://www.environmentmed.org/text.asp?2022/7/3/76/357448




  Introduction Top


The coronavirus disease 2019 (COVID-19) pandemic has changed the dynamics of health care once for all, and we have to continue to mount an unprecedented response to eventually defeat the novel virus pandemic. The available estimates suggest that as of June 12, 2022, a cumulative total of more than 533 million cases and 6.3 million deaths have been attributed to the infection.[1] Although the causative virus has predominantly affected the respiratory system and the majority of people have lost their lives to respiratory complications, even gastrointestinal and neurological manifestations have been reported.[2] There is a definite need to explore the association between COVID-19 infection and development or relation with the neurological manifestations, even in the absence of respiratory symptoms.[2],[3],[4]


  Coronavirus Disease 2019 Pandemic and Disruption of Essential Neurological Services Top


Similar to the disruption of other essential services since the emergence of the COVID-19 pandemic due to the reallocation of resources, even the basic services for neurological conditions (namely mental, neurological, and substance use disorders) experienced a toll.[5] These interruptions were reported due to the imposed travel restrictions because of the lockdown or owing to the closure of clinics, outpatient departments, and operation theaters.[5],[6] The findings of a survey done by the World Health Organization across close to 100 nations revealed that one out of the three nations had closed their inpatients' department during the period.[7] Further, it was found that 66% of the nations which completed the survey were not able to carry out surgical procedures for neurological disorders.[7] In addition, almost 35% of the nations' revealed difficulty encountered in the management of emergency neurological conditions owing to the diversion of available resources toward containment of the COVID-19 pandemic.[7]


  Coronavirus Disease 2019 Infection and Neurological Manifestations Top


A wide range of neurological manifestations have been reported among pediatric and adult patients with COVID-19 infection both during and after the patient has recovered from the illness. The findings of different studies and meta-analyses have reported clinical features to include signs of involvement of the corticospinal tract (namely diffuse hyperreflexia, ankle clonus, and bilateral extensor plantar reflexes).[8],[9],[10] In addition, patients have also presented with complaints of impairment of taste, smell, vision, hearing abilities, sensory, and cognition.[9],[10] Other neurological symptoms include agitation, fatigue, seizure, myalgia, headache, dizziness, acute confusion, disturbance of consciousness, tinnitus, and sleep disturbances.[9],[11] Further, among some patients of COVID-19 infection, neurological signs suggestive of cranial nerve palsy, hemiplegia/paresis, neuralgia, and ataxia have also been elicited.[8],[9],[10],[11]

In addition, patients have been also diagnosed with a variety of neurological diagnoses such as myopathy, neuropsychiatric disorders, encephalitis, Guillain–Barré syndrome, muscular disorders, stroke, status epilepticus, and cerebral venous thrombosis.[9],[10],[11],[12] To summarize, patients of COVID-19 infection tend to present with a wide range of neurological clinical features. A high index of suspicion will significantly improve the treatment outcome and will definitely result in a significant impact on the quality of life of the patients.[2] This calls for the need that we have to take specific steps to make health-care professionals involved in the treatment of patients of COVID-19 infection aware about the spectrum of symptoms, with or without the simultaneous presence of respiratory system involvement.[2]


  Post-Coronavirus Disease 2019 Neurological Sequelae Top


The available evidence clearly suggests the presence of new neurological manifestations after the acute phase of the infection is over.[11],[13] Post-COVID-19 condition refers to the illness that is reported among people with a positive history of confirmed or probable COVID-19 infection, usually <3 months from the time of detection of illness, with clinical manifestation being present for at least 2 months.[2],[7] In a retrospective cohort study done among more than 1,730 patients discharged from a hospital in Wuhan, China, between the period of January–May 2020, the patients reported complaints of fatigue, muscular weakness, sleep disturbances, anxiety, depression, and walking difficulties.[11]

The findings of another cohort study with a follow-up for 3-month duration identified a wide range of central nervous systems (namely encephalopathy, akinetic mutism, ischemic stroke, and transverse myelitis) and peripheral nervous system (such as polyneuromyopathy) complications.[13] Further, patients reported complaints such as amnestic dysfunction, dysexecutive syndrome, and ataxia at the time of discharge.[13] However, there is not much known about the neurological sequels among children and there is also a need for number of cohort studies to gain an in-depth understanding of these complications after the recovery from the acute infection.[2]

COVID-19 infection has been linked with long-term clinical manifestations, often termed as “long COVID.” In a study done in Italy, headache, fatigue, muscle aches/myalgia, articular pains, cognitive impairment, loss of concentration, and loss of smell were identified as the most common symptoms in the post-COVID period.[14] In addition, the study participants demonstrated significant levels of insomnia and a reduction in the overall reduced quality of life.[14] On a similar note, a number of long-term neurological manifestations, including progression in the onset of Alzheimer's disease, Parkinson's disease, and multiple sclerosis, have been reported.[15]


  Coronavirus Disease 2019 and Preexisting Neurological Conditions Top


A number of preexisting noncommunicable diseases (such as diabetes, hypertension, and cardiovascular diseases) are associated with the development of severe forms of infection and poor treatment outcomes.[16],[17] In terms of preexisting neurological conditions, people with these illnesses (such as stroke or dementia) are not only vulnerable to acquire the novel viral infection, but at the same time are prone to experience an exacerbation of their preexisting illnesses, and also have poor treatment outcome, including death.[18],[19] Similar sorts of findings were reported in another review, herein, preexisting neurological diseases are linked with severe forms of COVID-19 infection and higher rates of mortality.[20]


  Neurological Complications Postvaccination Top


The COVID-19 vaccine has been recommended for adult patients regardless of the presence of any neurological disorders. The reported evidence suggests the minimal risk of development of any neurological complications after being vaccinated.[21],[22] Complications such as Bell's palsy, cerebral venous sinus thrombosis, and Guillain–Barré syndrome have been reported, nevertheless, the risk of development of such complications is extremely less when compared with the risk associated with the acquisition of infection.[21],[22],[23] There is a need to generate more evidence on this aspect, nevertheless, as of now, COVID-19 vaccination should be administered to everyone.


  Implications for Future Top


As the neurological sequels of the COVID-19 infection are being gradually reported across different parts of the world, there is an immense need to strengthen the surveillance among people diagnosed with COVID-19 infection. We have to ensure that none of the sequels go unnoticed and all such events are reported. In addition, there is a need to understand the role and mechanism involved in the progression of other neurological disorders by the COVID-19 infection. Moreover, there is also a need to have a high index of suspicion toward the development of neurological complications and thus health-care professionals should be aware about the range of symptoms and clinical signs.


  Conclusion Top


To conclude, a wide range of acute and postacute neurological manifestations have been attributed to the COVID-19 infection worldwide. This calls for the need to create awareness among health-care professionals about neurological symptoms and complications in the post-COVID period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Weekly Epidemiological Update on COVID-19 – 15 June, 2022; 2022. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---15-june-2022. [Last accessed on 2022 Jun 20].  Back to cited text no. 1
    
2.
World Health Organization. Neurology and COVID-19 – Scientific Brief; 29 September, 2021. Geneva: WHO Press; 2021. p. 1-6.  Back to cited text no. 2
    
3.
Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767-83.  Back to cited text no. 3
    
4.
Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of covid-19 in the young. N Engl J Med 2020;382:e60.  Back to cited text no. 4
    
5.
Antonini A. Health care for chronic neurological patients after COVID-19. Lancet Neurol 2020;19:562-3.  Back to cited text no. 5
    
6.
García-Azorín D, Seeher KM, Newton CR, Okubadejo NU, Pilotto A, Saylor D, et al. Disruptions of neurological services, its causes and mitigation strategies during COVID-19: A global review. J Neurol 2021;268:3947-60.  Back to cited text no. 6
    
7.
World Health Organization. The Impact of COVID-19 on Mental, Neurological and Substance Use Services: Results of a Rapid Assessment. Geneva: WHO Press; 2020. p. 6-16.  Back to cited text no. 7
    
8.
Favas TT, Dev P, Chaurasia RN, Chakravarty K, Mishra R, Joshi D, et al. Neurological manifestations of COVID-19: A systematic review and meta-analysis of proportions. Neurol Sci 2020;41:3437-70.  Back to cited text no. 8
    
9.
Abdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Afamefuna Victor E, et al. Neurological and musculoskeletal features of COVID-19: A systematic review and meta-analysis. Front Neurol 2020;11:687.  Back to cited text no. 9
    
10.
Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network-United States, March-June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-8.  Back to cited text no. 10
    
11.
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: A cohort study. Lancet 2021;397:220-32.  Back to cited text no. 11
    
12.
Misra S, Kolappa K, Prasad M, Radhakrishnan D, Thakur KT, Solomon T, et al. Frequency of neurologic manifestations in COVID-19: A systematic review and meta-analysis. Neurology 2021;97:e2269-81.  Back to cited text no. 12
    
13.
Nersesjan V, Amiri M, Lebech AM, Roed C, Mens H, Russell L, et al. Central and peripheral nervous system complications of COVID-19: A prospective tertiary center cohort with 3-month follow-up. J Neurol 2021;268:3086-104.  Back to cited text no. 13
    
14.
Orrù G, Bertelloni D, Diolaiuti F, Mucci F, Di Giuseppe M, Biella M, et al. Long-COVID syndrome? A study on the persistence of neurological, psychological and physiological symptoms. Healthcare (Basel) 2021;9:575.  Back to cited text no. 14
    
15.
Wang F, Kream RM, Stefano GB. Long-term respiratory and neurological sequelae of COVID-19. Med Sci Monit 2020;26:e928996.  Back to cited text no. 15
    
16.
Hernández-Galdamez DR, González-Block MÁ, Romo-Dueñas DK, Lima-Morales R, Hernández-Vicente IA, Lumbreras-Guzmán M, et al. Increased risk of hospitalization and death in patients with COVID-19 and pre-existing noncommunicable diseases and modifiable risk factors in Mexico. Arch Med Res 2020;51:683-9.  Back to cited text no. 16
    
17.
Chang AY, Cullen MR, Harrington RA, Barry M. The impact of novel coronavirus COVID-19 on noncommunicable disease patients and health systems: A review. J Intern Med 2021;289:450-62.  Back to cited text no. 17
    
18.
García-Azorín D, Martínez-Pías E, Trigo J, Hernández-Pérez I, Valle-Peñacoba G, Talavera B, et al. Neurological comorbidity is a predictor of death in covid-19 disease: A cohort study on 576 patients. Front Neurol 2020;11:781.  Back to cited text no. 18
    
19.
Kim SW, Kim SM, Kim YK, Kim JY, Lee YM, Kim BO, et al. Clinical characteristics and outcomes of COVID-19 cohort patients in Daegu Metropolitan City outbreak in 2020. J Korean Med Sci 2021;36:e12.  Back to cited text no. 19
    
20.
Fridman S, Bres Bullrich M, Jimenez-Ruiz A, Costantini P, Shah P, Just C, et al. Stroke risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases. Neurology 2020;95:e3373-85.  Back to cited text no. 20
    
21.
Ozonoff A, Nanishi E, Levy O. Bell's palsy and SARS-CoV-2 vaccines. Lancet Infect Dis 2021;21:450-2.  Back to cited text no. 21
    
22.
Keddie S, Pakpoor J, Mousele C, Pipis M, Machado PM, Foster M, et al. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barré syndrome. Brain 2021;144:682-93.  Back to cited text no. 22
    
23.
Lunn MP, Cornblath DR, Jacobs BC, Querol L, van Doorn PA, Hughes RA, et al. COVID-19 vaccine and Guillain-Barré syndrome: Let's not leap to associations. Brain 2021;144:357-60.  Back to cited text no. 23
    




 

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