151
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Alsufyani HA, Alrefaie Z. Renin-Angiotensin System Implications to COVID-19 Comorbidities. J Microsc Ultrastruct 2020; 8:148-151. [PMID: 33623738 PMCID: PMC7883491 DOI: 10.4103/jmau.jmau_105_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
The role of the renin-angiotensin system (RAS) and its pharmacological modulators in the susceptibility and outcomes of SARS CoV-2 pandemic (COVID-19) has been much discussed recently. Angiotensin-converting enzyme type 2 (ACE2) has attracted much attention and debate in relevance to COVID-19. It not only acts as the receptor to which the SARS CoV-2 virus binds to be introduced into cells but also balances the effects of angiotensin II offering anti-inflammatory and antifibrotic protective actions to different organs. This mini-review aims to shed some light on the possible involvement of ACE2 and RAS alternate pathways in the comorbidities and clinical findings observed in COVID-19 patients.
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Affiliation(s)
- Hadeel A. Alsufyani
- Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zienab Alrefaie
- Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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152
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Khatoon F, Prasad K, Kumar V. Neurological manifestations of COVID-19: available evidences and a new paradigm. J Neurovirol 2020; 26:619-630. [PMID: 32839951 PMCID: PMC7444681 DOI: 10.1007/s13365-020-00895-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 01/01/2023]
Abstract
The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients.
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Affiliation(s)
- Fatima Khatoon
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India
| | - Kartikay Prasad
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India
| | - Vijay Kumar
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India.
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153
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Bhatia R, Pedapati R, Komakula S, Srivastava MVP, Vishnubhatla S, Khurana D. Stroke in Coronavirus Disease 2019: A Systematic Review. J Stroke 2020; 22:324-335. [PMID: 33053948 PMCID: PMC7568983 DOI: 10.5853/jos.2020.02264] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19.
Methods Three authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables.
Results We identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase.
Conclusions The association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.
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Affiliation(s)
- Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Snigdha Komakula
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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154
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Padda I, Khehra N, Jaferi U, Parmar MS. The Neurological Complexities and Prognosis of COVID-19. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2025-2036. [PMID: 33015552 PMCID: PMC7522181 DOI: 10.1007/s42399-020-00527-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
Several neurological manifestations and complications linked to SARS-CoV-2 have been reported along with well-known respiratory pathology. The global active transmission of SARS-CoV-2 and its unexplained characteristics has led to a pandemic. Since its rapid emergence from Wuhan, China, in December 2019, several studies have reported the impacts of COVID-19 on the CNS and PNS and its implications. This comprehensive review article comprises case reports, case series, metaanalysis, cohort studies, retrospective studies, and narrative reviews focusing on COVID-19-associated CNS and PNS complexities. The authors searched for over 200 articles and used 52 publications related to the neurological complexities of COVID-19 affecting the CNS and PNS as part of the literature review process. The predominant CNS symptoms noted in COVID-19 patients were headaches and dizziness, and the most common PNS symptoms were alterations in smell and taste. Case reports on headache/dizziness, intracerebral hemorrhage, acute hemorrhagic necrotizing encephalopathy, meningitis/encephalitis, encephalopathy, cerebrovascular events, chemosensory dysfunction, Guillain-Barre syndrome, and acute transverse myelitis/acute necrotizing myelitis in PCR-confirmed SARS-CoV-2 subjects are also reported. New-onset neurological symptoms were also observed in children with PCR-confirmed SARS-CoV-2 that developed pediatric multisystem inflammatory syndrome (PIMS). This comprehensive review article will assist the clinicians and researchers to gain information about the neurological manifestations and complications associated with COVID-19 and develop planning to treat these symptoms in concerned patients of all ages. However, it is unclear whether SARS-CoV2-associated neurological effects are due to primary infections or secondary response to the possible mechanisms discussed in this review.
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Affiliation(s)
| | - Nimrat Khehra
- Caribbean Medical University School of Medicine, Willemstad, Curaçao
| | - Urooj Jaferi
- All Saints University School of Medicine, Roseau, Dominica
| | - Mayur S. Parmar
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa Bay Campus, Clearwater, FL USA
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155
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Jakhmola S, Indari O, Chatterjee S, Jha HC. SARS-CoV-2, an Underestimated Pathogen of the Nervous System. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2137-2146. [PMID: 33015550 PMCID: PMC7520376 DOI: 10.1007/s42399-020-00522-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/08/2023]
Abstract
Numerous clinical studies have reported neurological symptoms in COVID-19 patients since the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), apart from the atypical signs of pneumonia. Angiotensin-converting enzyme-2 (ACE-2), a potential receptor for SARS-CoV-2 entry, is expressed on various brain cells and cerebral parts, i.e., subfornical organ, paraventricular nucleus, nucleus of the tractus solitarius, and rostral ventrolateral medulla, as well as in non-cardiovascular areas such as the motor cortex and raphe. The resident CNS cells like astrocytes and microglia also express ACE-2, thus highlighting the vulnerability of the nervous system to SARS-CoV-2 infection. Additionally, transmembrane serine protease 2 (TMPRSS2) and furin facilitate virus entry into the host. Besides, the probable routes of virus entry into the nervous system include the hematogenic pathway, through the vagus, the olfactory nerve, or the enteric nervous system. However, the trajectory of SARS-CoV-2 to the brain needs investigation. Furthermore, a Th17-mediated cytokine storm is seen in COVID-19 cases with higher levels of IL-1β/2/7/8/9/10/17, GM-CSF, IFN-γ, TNF-α, CXCL-10, MCP1, and MIP1α/β. Some cytokines can cross the blood-brain barrier and activate the brain's immune cells to produce neural cytokines, leading to neuronal dysfunctions. Nonetheless, most of the neurological conditions developed due to viral infections may not have effective and registered treatments. Although, some antivirals may inhibit the virus-mediated pathogenesis and prove to be suitable in COVID-19 treatment. Therefore, clinicians' and researchers' collective expertise may unravel the potential of SARS-CoV-2 infection to prevent short-term and long-term CNS damage.
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Affiliation(s)
- Shweta Jakhmola
- Infection Bio-engineering Group, Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Lab No. 302, School Building, Indore, Madhya Pradesh 453552 India
| | - Omkar Indari
- Infection Bio-engineering Group, Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Lab No. 302, School Building, Indore, Madhya Pradesh 453552 India
| | - Sayantani Chatterjee
- Infection Bio-engineering Group, Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Lab No. 302, School Building, Indore, Madhya Pradesh 453552 India
| | - Hem Chandra Jha
- Infection Bio-engineering Group, Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Lab No. 302, School Building, Indore, Madhya Pradesh 453552 India
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156
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Philips CA, Mohan N, Ahamed R, Kumbar S, Rajesh S, George T, Mohanan M, Augustine P. One disease, many faces-typical and atypical presentations of SARS-CoV-2 infection-related COVID-19 disease. World J Clin Cases 2020; 8:3956-3970. [PMID: 33024752 PMCID: PMC7520786 DOI: 10.12998/wjcc.v8.i18.3956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/10/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023] Open
Abstract
Since the appearance of the novel coronavirus (severe acute respiratory syndrome-coronavirus-2) and related coronavirus disease 2019 (COVID-19) in China in December 2019, a very high number of small and large patient series have been published in literature from around the world. Even though the classical presentation of COVID-19 is one with respiratory symptoms with or without pneumonia that can be self-limiting or evolve into severe respiratory distress syndrome with multiple organ failure, and secondary bacterial sepsis, a large body of evidence suggests a plethora of other types of clinical presentation. In this exhaustive review, we reviewed all of the published literature on COVID-19 to identify different types of clinical presentations affecting various organ systems, to provide an in-depth analysis that may prove useful for clinicians and health-workers on the frontline, battling the severe pandemic.
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Affiliation(s)
- Cyriac Abby Philips
- The Liver Unit and Monarch, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
| | - Narain Mohan
- The Liver Unit and Monarch, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
| | - Rizwan Ahamed
- Gastroenterology and Advanced GI Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
| | - Sandeep Kumbar
- Gastroenterology and Advanced GI Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
| | - Sasidharan Rajesh
- Division of Hepatobiliary Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
| | - Tom George
- Division of Hepatobiliary Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
| | - Meera Mohanan
- Anesthesia and Critical Care, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
| | - Philip Augustine
- Gastroenterology and Advanced GI Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Cochin 682025, Kerala, India
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157
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Saini SK, Anand KS, Juneja A, Mahajan RK. Neurological Problems in COVID-19 Pandemic. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2020. [DOI: 10.1055/s-0040-1717833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractCoronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This outbreak, which emerged in Wuhan city, rapidly spread throughout China and has now become a global public health concern. SARS-CoV-2 is a highly pathogenic and transmissible virus. Common clinical manifestations of COVID-19 include fever, dry cough, shortness of breath, muscle ache, headache, and confusion. Currently, there is no confirmed effective therapeutic strategy for COVID-19 because the pathological mechanism is poorly understood. In addition to the respiratory system involvement, recent evidence has shown that SARS-CoV-2 can affect other organ systems including nervous, vascular, digestive, and urinary system. Various neurological complications have also been described in various studies. Nervous system involvement in the case of SARS-CoV-2 is explained by direct neuro invasion, immune mechanism, and other systemic factors. Neurological complications due to SARS-CoV-2 include both central and peripheral nervous system involvement. Central nervous system complications range from mild headache to seizures, encephalitis, myelitis, and acute cerebrovascular accidents. Peripheral nervous system complications range from vague muscle pains to Guillain–Barré syndrome. This article briefly discusses the various neurological and mental health issues related to COVID-19.
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Affiliation(s)
- Shiv Kumar Saini
- Department of Neurology, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Abhishek Juneja
- Department of Neurology, Dr Ram Manohar Lohia Hospital, New Delhi, India
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158
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Vohora D, Jain S, Tripathi M, Potschka H. COVID-19 and seizures: Is there a link? Epilepsia 2020; 61:1840-1853. [PMID: 32944929 PMCID: PMC7537056 DOI: 10.1111/epi.16656] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/14/2020] [Accepted: 07/24/2020] [Indexed: 12/15/2022]
Abstract
The rapid spread of the SARS‐CoV‐2 pandemic poses particular challenges to the management of persons with chronic disease. Reports of a possible neuroinvasiveness of SARS‐CoV‐2 as well as pathophysiological mechanisms and indirect consequences in severe COVID‐19 cases raise the question of whether the infection can be associated with an increased risk of seizure recurrence or the development of new onset and acute symptomatic seizures. Although the literature does not provide relevant evidence for seizure worsening in persons with epilepsy during the course of a SARS‐CoV‐2 infection, there are theoretical risks, for example, seizures triggered by fever. Moreover, a severe disease course and advanced disease stages can, for instance, result in hypoxic encephalopathy, cerebrovascular events, and cytokine storm, which may trigger the development of acute seizures. This is further confirmed by reports of occasional seizures in COVID‐19 patients. Although the low number of reports so far suggests that the risk may be relatively low, the reports indicate that an early neurological manifestation with seizures should not be ruled out. In the context of these cases, we discuss possible pathophysiological mechanisms that may trigger ictogenesis in patients with SARS‐CoV‐2 infection.
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Affiliation(s)
- Divya Vohora
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Shreshta Jain
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University (LMU), Königinstr. 16, D-80539, Munich, Germany
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159
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Förster M, Weyers V, Küry P, Barnett M, Hartung HP, Kremer D. Neurological manifestations of severe acute respiratory syndrome coronavirus 2-a controversy 'gone viral'. Brain Commun 2020; 2:fcaa149. [PMID: 33210085 PMCID: PMC7543269 DOI: 10.1093/braincomms/fcaa149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 first appeared in December 2019 in Wuhan, China, and developed into a worldwide pandemic within the following 3 months causing severe bilateral pneumonia (coronavirus disease 2019) with in part fatal outcomes. After first experiences and tentative strategies to face this new disease, several cases were published describing severe acute respiratory syndrome coronavirus 2 infection related to the onset of neurological complaints and diseases such as, for instance, anosmia, stroke or meningoencephalitis. Of note, there is still a controversy about whether or not there is a causative relation between severe acute respiratory syndrome coronavirus 2 and these neurological conditions. Other concerns, however, seem to be relevant as well. This includes not only the reluctance of patients with acute neurological complaints to report to the emergency department for fear of contracting severe acute respiratory syndrome coronavirus 2 but also the ethical and practical implications for neurology patients in everyday clinical routine. This paper aims to provide an overview of the currently available evidence for the occurrence of severe acute respiratory syndrome coronavirus 2 in the central and peripheral nervous system and the neurological diseases potentially involving this virus.
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Affiliation(s)
- Moritz Förster
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Vivien Weyers
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Patrick Küry
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Michael Barnett
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
- Center of Neurology and Neuropsychiatry, LVR Klinikum, Medical Faculty, Heinrich-Heine-University, 40629 Düsseldorf, Germany
| | - David Kremer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
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160
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Orrù G, Conversano C, Malloggi E, Francesconi F, Ciacchini R, Gemignani A. Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6688. [PMID: 32937949 PMCID: PMC7558767 DOI: 10.3390/ijerph17186688] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) outbreak has shocked the whole world with its unexpected rapid spread. The virus responsible for the disease, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), enters host cells by means of the envelope spike protein, which binds to angiotensin-converting enzyme 2 receptors. These receptors are highly expressed in heart, lungs, respiratory tract epithelium, endothelial cells and brain. Since an increasing body of significant evidence is highlighting a possible neuroinvasion related to SARS-CoV-2, a state of the art on the neurological complications is needed. To identify suitable publications, our systematic review was carried out by searching relevant studies on PubMed and Scopus databases. We included studies investigating neurologic manifestations of SARS-CoV-2 in patients over 18. According to the analyzed studies, the most frequent disorders affecting central nervous system (CNS) seem to be the following: olfactory and taste disorders, ischemic/hemorrhagic stroke, meningoencephalitis and encephalopathy, including acute necrotizing encephalopathy, a rare type of encephalopathy. As regards the peripheral nervous system (PNS), Guillain-Barré and Miller Fisher syndromes are the most frequent manifestations reported in the literature. Important clinical information on the neurological manifestations of SARS-CoV-2 would help clinicians raise awareness and simultaneously improve the prognosis of critically ill patients.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical and Molecular & Critical Area Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy; (C.C.); (E.M.); (F.F.); (R.C.); (A.G.)
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161
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Rahman A, Niloofa R, De Zoysa IM, Cooray AD, Kariyawasam J, Seneviratne SL. Neurological manifestations in COVID-19: A narrative review. SAGE Open Med 2020; 8:2050312120957925. [PMID: 32974019 PMCID: PMC7491214 DOI: 10.1177/2050312120957925] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/20/2020] [Indexed: 01/05/2023] Open
Abstract
COVID-19, a respiratory viral infection, has affected more than 10 million individuals worldwide. Common symptoms include fever, dry cough, fatigue and shortness of breath. Some patients show neurological manifestations such as headache, dizziness, cerebrovascular disease, peripheral nerve and muscle symptoms and smell and taste impairment. In previous studies, SARS-CoV-1 and MERS-CoV were found to affect the nervous system. Given the high similarity between SARS-CoV-1 and SARS-CoV-2, effects on the nervous system by SARS-CoV-2 are a possibility. We have outlined the common neurological manifestations in COVID-19 (information are up-to-date as of June 2020) and discussed the possible pathogenetic mechanisms and management options.
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Affiliation(s)
- Asma Rahman
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Roshan Niloofa
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - Ishan M De Zoysa
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Akila D Cooray
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - Jayani Kariyawasam
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
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162
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Saeed A, Shorafa E. Status epilepticus as a first presentation of COVID-19 infection in a 3 years old boy; Case report and review the literature. IDCases 2020; 22:e00942. [PMID: 32895630 PMCID: PMC7468313 DOI: 10.1016/j.idcr.2020.e00942] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/25/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
It was December 2019 that china reported series of patients with respiratory symptoms, a disease that later named COVID-19; and from there spread to other countries around the world; and in February 2020, the world health organization declared COVID-19 as a pandemic. From the beginning, it was assumed that COVID-19 occurrence in pediatric patients is less and has less severity but nowadays; there are a reports that shows severe cases with multiple organ involvement. The most manifestation symptom is fever but convulsion is rare as the first manifestation symptom. Here we describe a 3 years old; previously healthy boy that presented with repeated fever induced seizure and status epilepticus and positive RT-PCR for COVID-19 that in the first day; brain CT scan revealed brain edema and 5 days later, there was intracerebral hemorrhage in brain MRI.
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Affiliation(s)
- Amir Saeed
- Department of Pediatrics, Division of Pediatric Intensive Care, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Eslam Shorafa
- Department of Pediatrics, Division of Pediatric Intensive Care, Shiraz University of Medical Sciences, Shiraz, Iran
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163
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Lopez-Fernández A, Quintana-Diaz M, Sánchez-Sánchez M. Diffuse axonal injury associated with COVID-19 infection. MEDICINA CLÍNICA (ENGLISH EDITION) 2020; 155:274-275. [PMID: 32923676 PMCID: PMC7473021 DOI: 10.1016/j.medcle.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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164
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Lopez-Fernández A, Quintana-Diaz M, Sánchez-Sánchez M. Lesión axonal difusa asociada a infección por COVID-19. Med Clin (Barc) 2020; 155:274-275. [PMID: 32576367 PMCID: PMC7290231 DOI: 10.1016/j.medcli.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/18/2022]
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165
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Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol 2020; 19:767-783. [PMID: 32622375 PMCID: PMC7332267 DOI: 10.1016/s1474-4422(20)30221-0] [Citation(s) in RCA: 1310] [Impact Index Per Article: 327.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is of a scale not seen since the 1918 influenza pandemic. Although the predominant clinical presentation is with respiratory disease, neurological manifestations are being recognised increasingly. On the basis of knowledge of other coronaviruses, especially those that caused the severe acute respiratory syndrome and Middle East respiratory syndrome epidemics, cases of CNS and peripheral nervous system disease caused by SARS-CoV-2 might be expected to be rare. RECENT DEVELOPMENTS A growing number of case reports and series describe a wide array of neurological manifestations in 901 patients, but many have insufficient detail, reflecting the challenge of studying such patients. Encephalopathy has been reported for 93 patients in total, including 16 (7%) of 214 hospitalised patients with COVID-19 in Wuhan, China, and 40 (69%) of 58 patients in intensive care with COVID-19 in France. Encephalitis has been described in eight patients to date, and Guillain-Barré syndrome in 19 patients. SARS-CoV-2 has been detected in the CSF of some patients. Anosmia and ageusia are common, and can occur in the absence of other clinical features. Unexpectedly, acute cerebrovascular disease is also emerging as an important complication, with cohort studies reporting stroke in 2-6% of patients hospitalised with COVID-19. So far, 96 patients with stroke have been described, who frequently had vascular events in the context of a pro-inflammatory hypercoagulable state with elevated C-reactive protein, D-dimer, and ferritin. WHERE NEXT?: Careful clinical, diagnostic, and epidemiological studies are needed to help define the manifestations and burden of neurological disease caused by SARS-CoV-2. Precise case definitions must be used to distinguish non-specific complications of severe disease (eg, hypoxic encephalopathy and critical care neuropathy) from those caused directly or indirectly by the virus, including infectious, para-infectious, and post-infectious encephalitis, hypercoagulable states leading to stroke, and acute neuropathies such as Guillain-Barré syndrome. Recognition of neurological disease associated with SARS-CoV-2 in patients whose respiratory infection is mild or asymptomatic might prove challenging, especially if the primary COVID-19 illness occurred weeks earlier. The proportion of infections leading to neurological disease will probably remain small. However, these patients might be left with severe neurological sequelae. With so many people infected, the overall number of neurological patients, and their associated health burden and social and economic costs might be large. Health-care planners and policy makers must prepare for this eventuality, while the many ongoing studies investigating neurological associations increase our knowledge base.
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Affiliation(s)
- Mark A Ellul
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre National Health Service (NHS) Foundation Trust, Liverpool, UK
| | - Laura Benjamin
- Queen Square Institute of Neurology, University College London, London, UK
| | - Bhagteshwar Singh
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK; Christian Medical College, Vellore, India
| | - Suzannah Lant
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Benedict Daniel Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre National Health Service (NHS) Foundation Trust, Liverpool, UK
| | - Ava Easton
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Encephalitis Society, Malton, UK
| | - Rachel Kneen
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sylviane Defres
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jim Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre National Health Service (NHS) Foundation Trust, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
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166
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Hemorrhagic stroke in hispanics with severe SARS-CoV2 infection. J Neurol Sci 2020; 416:117046. [PMID: 32717534 PMCID: PMC7363595 DOI: 10.1016/j.jns.2020.117046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/23/2022]
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167
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Romoli M, Jelcic I, Bernard‐Valnet R, García Azorín D, Mancinelli L, Akhvlediani T, Monaco S, Taba P, Sellner J. A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details. Eur J Neurol 2020; 27:1712-1726. [PMID: 32503088 PMCID: PMC7300895 DOI: 10.1111/ene.14382] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE We systematically reviewed available evidence for reports of neurological signs and symptoms in patients with COVID-19 to identify cases with severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection or immune-mediated reaction in the nervous system. METHODS We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for articles on COVID-19 and nervous system involvement that were published from 1 January to 24 April 2020. Data on design, sample size, neurological assessment and related work-up were extracted. Biases were assessed with the Newcastle-Ottawa scale. RESULTS We analysed 27 publications on potential neuroinvasive or parainfectious neurological complications of COVID-19. The reports focused on smell and taste (n = 5) and evaluation of neurological symptoms and signs in cohorts (n = 5). There were cases of Guillain-Barré syndrome/Miller-Fisher syndrome/cranial neuropathy (seven cases), meningitis/encephalitis (nine cases) and various other conditions (five cases). The number of patients with examination of cerebrospinal fluid and, in particular, SARS-CoV-2 polymerase chain reaction was negligible. Two had a positive SARS-CoV-2 polymerase chain reaction examination of cerebrospinal fluid specimen. Study of potential parenchymal involvement with magnetic resonance imaging was rare. Only four reports received a rating of the highest quality standards. CONCLUSIONS This systematic review failed to establish comprehensive insights into nervous system manifestations of COVID-19 beyond immune-mediated complications in the aftermath of respiratory symptoms. The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS-CoV-2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.
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Affiliation(s)
- M. Romoli
- Neurology UnitMaurizio Bufalini HospitalCesenaItaly
- Neurology ClinicUniversity of Perugia – S. Maria della Misericordia HospitalPerugiaItaly
| | - I. Jelcic
- Neuroimmunology and Multiple Sclerosis Research SectionDepartment of NeurologyUniversity Hospital of ZurichZurichSwitzerland
| | - R. Bernard‐Valnet
- Department of Clinical NeurosciencesLausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and University of LausanneLausanneSwitzerland
| | - D. García Azorín
- Department of NeurologyHospital Clinico de ValladolidValladolidSpain
| | | | - T. Akhvlediani
- American MD ProgramFaculty of MedicineTbilisi State Medical UniversityTblisiGeorgia
| | - S. Monaco
- Department of Neuroscience, Biomedicine and Movement SciencesUniversity Hospital of VeronaVeronaItaly
| | - P. Taba
- Department of Neurology and NeurosurgeryInstitute of Clinical MedicineUniversity of TartuTartuEstonia
- Neurology ClinicTartu University HospitalTartuEstonia
| | - J. Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
- Department of NeurologyChristian Doppler Medical CenterParacelsus Medical UniversitySalzburgAustria
- Department of NeurologyKlinikum rechts der IsarTechnische Universität MünchenMünchenGermany
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168
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Degeneffe A, Bruneau M, Spitaels J, Gilis N, De Witte O, Lubansu A. Acute Hemorrhage After Intracerebral Biopsy in COVID-19 Patients: Report of 3 Cases. World Neurosurg 2020; 141:157-161. [PMID: 32526365 PMCID: PMC7280117 DOI: 10.1016/j.wneu.2020.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND When Belgium's coronavirus disease 2019 (COVID-19) outbreak began in March 2020, our neurosurgical department followed the protocol of most surgical departments in the world and postponed elective surgery. However, patients with tumor-like brain lesions requiring urgent surgery still received treatment as usual, in order to ensure ongoing neurooncologic care. From a series of 31 patients admitted for brain surgery, 3 were confirmed as infected by the novel severe acute respiratory syndrome coronavirus 2. CASE DESCRIPTION We present the clinical outcomes of these 3 COVID-19 patients, who underwent an intracerebral biopsy in our department during April 2020. All suffered from a diffuse intraparenchymal hemorrhage postoperatively. Unfortunately, we were not able to identify a clear etiology of these postoperative complications. It could be hypothesized that an active COVID-19 infection status may be related to a higher bleeding risk. The remaining 28 neurooncologic non-COVID-19 patients underwent uneventful surgery during the same period. CONCLUSIONS This case series reports the previously unreported and unexpected outcomes of COVID-19 patients suffering from acute hemorrhage after intracerebral biopsy procedures. Although no direct relation can yet be established, we recommend the neurosurgical community be cautious in such cases.
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Affiliation(s)
| | - Michaël Bruneau
- Department of Neurosurgery, Erasmus Hospital, Brussels, Belgium
| | - Julien Spitaels
- Department of Neurosurgery, Erasmus Hospital, Brussels, Belgium
| | - Nathalie Gilis
- Department of Neurosurgery, Erasmus Hospital, Brussels, Belgium
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169
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Rachel JB, Gururaj N, Smitha T, Daniel TD, Harishini BS, Rosaian AS. Innovative diagnostic approach and investigation trends in COVID19-A systematic review. J Oral Maxillofac Pathol 2020; 24:421-436. [PMID: 33967476 PMCID: PMC8083432 DOI: 10.4103/jomfp.jomfp_395_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 10/20/2020] [Indexed: 01/19/2023] Open
Abstract
A highly contagious viral infection emerged in Wuhan city; China had increased mortality with uncertain pathogenesis spreads throughout the world to become a pandemic. It is reported to be caused by a member of β coronaviruses and named it as COVID-19 by the World Health Organization (WHO). The disease is caused by a mutant strain of coronavirus SARS-COV-2 that affects the respiratory tract causing mild to severe respiratory tract illness. The clinical manifestation ranges from mild, moderate, severe and very severe signs and symptoms result in death due to severe hypoxia or multi-organ dysfunction. Also, the affected persons were capable of infecting others through various modes of transmission through respiratory droplets (aerosol spread). A definite investigation protocol has followed to diagnose COVID 19 disease but mainly confirmed with reverse transcription polymerase chain reaction. Computerized tomography scan plays a significant role in the diagnosis and prognosis of affected individuals. The major problem with COVID-19 is due to its novelty and lack of vaccination or treatment. This review focuses on the mutation, pathogenesis, various diagnostic tests adopted and autopsy findings in patients affected with COVID-19.
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Affiliation(s)
- J Beryl Rachel
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - N Gururaj
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - T Smitha
- Department of Oral Pathology and Microbiology, Vokkaligara Sangha Dental College and Hosipital, Bengaluru, Karnataka, India
| | - T Divyna Daniel
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - B S Harishini
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Adlin Saroja Rosaian
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
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170
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Gogia B, Fang X, Rai P. Intracranial Hemorrhage in a Patient With COVID-19: Possible Explanations and Considerations. Cureus 2020; 12:e10159. [PMID: 32884879 PMCID: PMC7462644 DOI: 10.7759/cureus.10159] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/05/2022] Open
Abstract
Some of the reported neurological manifestations of COVID-19 are encephalopathy, headache, ischemic, hemorrhagic stroke, Miller Fisher syndrome, cranial neuropathies, and Guillain-Barre syndrome. We report a case of a 75-year-old COVID-19 patient with life-threatening intracranial hemorrhage. The initial labs on admission showed D-dimer of 1.04 µg/mL, which increased to 3.74 µg/mL the next day, PT/INR of 13.7 seconds/1.2, aPTT of 22 seconds, fibrinogen of 386 mg/dL, WBC of 9.71 K/µL, Hgb of 14.1 g/dL, platelet of 315 x 103/µL, LDH of 965 U/L, and CRP of 35.2 mg/dL. In addition to aspirin and Plavix (clopidogrel), the patient was started on a therapeutic dose of enoxaparin due to elevated D-dimer. A few days later, the patient had a change in the neurological examination. The CT of the head without contrast revealed a left-sided acute subdural hematoma, causing left to right midline shift, a large left temporal intraparenchymal, and subarachnoid hemorrhage with transtentorial herniation, leading to death. This case illustrates a combination of factors including hypertension, triple therapy (aspirin, clopidogrel, and enoxaparin), and underlying coagulopathy due to COVID-19, which contributed to the life-threatening intracranial hemorrhage in this patient. Therefore, this raises a concern about the safety of starting these patients preemptively on a therapeutic dose of anticoagulation.
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Affiliation(s)
- Bhanu Gogia
- Neurology, University of Texas Medical Branch, Galveston, USA
| | - Xiang Fang
- Neurology, University of Texas Medical Branch, Galveston, USA
| | - Prashant Rai
- Neurology, University of Texas Medical Branch, Galveston, USA
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171
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Abstract
Purpose of Review To review current literature on endothelial dysfunction with previous coronaviruses, and present available data on the role of endothelial dysfunction in coronavirus disease-2019 (COVID-19) infection in terms of pathophysiology and clinical phenotype Recent Findings Recent evidence suggests that signs and symptoms of severe COVID-19 infection resemble the clinical phenotype of endothelial dysfunction, implicating mutual pathophysiological pathways. Dysfunction of endothelial cells is believed to mediate a variety of viral infections, including those caused by previous coronaviruses. Experience from previous coronaviruses has triggered hypotheses on the role of endothelial dysfunction in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which are currently being tested in preclinical and clinical studies. Summary Endothelial dysfunction is the common denominator of multiple clinical aspects of severe COVID-19 infection that have been problematic for treating physicians. Given the global impact of this pandemic, better understanding of the pathophysiology could significantly affect management of patients.
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172
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Fayed I, Pivazyan G, Conte AG, Chang J, Mai JC. Intracranial hemorrhage in critically ill patients hospitalized for COVID-19. J Clin Neurosci 2020; 81:192-195. [PMID: 33222915 PMCID: PMC7434499 DOI: 10.1016/j.jocn.2020.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/05/2020] [Accepted: 08/16/2020] [Indexed: 01/02/2023]
Abstract
In this study, we report three cases of spontaneous intracranial hemorrhage in patients who were initially hospitalized at our tertiary care center in Washington, DC with symptoms of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all three patients, who were critically ill, requiring intubation and ventilatory support. During their protracted hospitalizations, subsequent imaging disclosed intracranial hemorrhages, including intracerebral and subarachnoid hemorrhages, in the context of anticoagulation and coagulopathy. We believe this is related to the tropism of SARS-CoV-2 to the endothelial lining of the cerebral vasculature via their angiotensin-converting enzyme (ACE) II receptors. Given our findings, we advocate heightened vigilance for intracerebral hemorrhage events, and scanning when practicable, in COVID-19 patients which have prolonged ventilatory support and depressed neurologic examinations.
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Affiliation(s)
- Islam Fayed
- MedStar Georgetown University Hospital, Department of Neurosurgery, 3800 Reservoir Road NW, 7PHC, Washington, DC 20007, USA; MedStar Washington Hospital Center, Department of Neurosurgery, 110 Irving Street NW, Washington, DC 20010, USA
| | - Gnel Pivazyan
- MedStar Georgetown University Hospital, Department of Neurosurgery, 3800 Reservoir Road NW, 7PHC, Washington, DC 20007, USA; MedStar Washington Hospital Center, Department of Neurosurgery, 110 Irving Street NW, Washington, DC 20010, USA
| | - Anthony G Conte
- MedStar Georgetown University Hospital, Department of Neurosurgery, 3800 Reservoir Road NW, 7PHC, Washington, DC 20007, USA; MedStar Washington Hospital Center, Department of Neurosurgery, 110 Irving Street NW, Washington, DC 20010, USA
| | - Jason Chang
- MedStar Washington Hospital Center, Department of Critical Care Medicine, 110 Irving Street NW, Washington, DC 20010, USA
| | - Jeffrey C Mai
- MedStar Georgetown University Hospital, Department of Neurosurgery, 3800 Reservoir Road NW, 7PHC, Washington, DC 20007, USA; MedStar Washington Hospital Center, Department of Neurosurgery, 110 Irving Street NW, Washington, DC 20010, USA.
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173
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Khattar NK, Sharma M, McCallum AP, Oxford BG, Zeb H, Suliman SA, Sieg EP, Mocco J, Neimat JS, Zemmar A. Intracranial hemorrhage in a young COVID-19 patient. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020; 22:100878. [PMID: 32837915 PMCID: PMC7419270 DOI: 10.1016/j.inat.2020.100878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 12/30/2022]
Abstract
COVID-19 patients are increasingly understood to develop multisystem manifestations, including neurologic involvement. We report the case of a 42-year old COVID-19 positive patient with a fatal intracerebral hemorrhage (ICH). The patient presented with fever and dyspnea, requiring intubation due to medical complications. After prolonged sedation and anticoagulation, the patient suddenly developed bilaterally fixed and dilated pupils, caused by a right-sided intracranial hemorrhage with uncal herniation. The course of this case illustrates the delicate balance between hypercoagulability and coagulation factor depletion; especially in the intubated and sedated patient, in whom regular neurological assessments are impeded. As we expand our understanding of the neurological ramifications of COVID-19, clinicians need to be increasingly aware of the precarious coagulation balance.
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Affiliation(s)
- Nicolas K Khattar
- Department of Neurosurgery, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA
| | - Mayur Sharma
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA
| | - Abigail P McCallum
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA
| | - Brent G Oxford
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA
| | - Hassan Zeb
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Sally A Suliman
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Emily P Sieg
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA
| | - J Mocco
- Department of Neurological Surgery, Mount Sinai Medical Center, New York, NY USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA
| | - Ajmal Zemmar
- Department of Neurosurgery, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA
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174
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Porzionato A, Emmi A, Stocco E, Barbon S, Boscolo-Berto R, Macchi V, De Caro R. The potential role of the carotid body in COVID-19. Am J Physiol Lung Cell Mol Physiol 2020; 319:L620-L626. [PMID: 32755325 PMCID: PMC7516384 DOI: 10.1152/ajplung.00309.2020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The carotid body (CB) plays a contributory role in the pathogenesis of various respiratory, cardiovascular, renal, and metabolic diseases through reflex changes in ventilation and sympathetic output. On the basis of available data about peripheral arterial chemoreception and severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), a potential involvement in the coronavirus disease 2019 (COVID-19) may be hypothesized through different mechanisms. The CB could be a site of SARS-CoV-2 invasion, due to local expression of its receptor [angiotensin-converting enzyme (ACE) 2] and an alternative route of nervous system invasion, through retrograde transport along the carotid sinus nerve. The CB function could be affected by COVID-19-induced inflammatory/immune reactions and/or ACE1/ACE2 imbalance, both at local or systemic level. Increased peripheral arterial chemosensitivity and reflex sympatho-activation may contribute to the increased morbidity and mortality in COVID-19 patients with respiratory, cardiovascular, renal, or metabolic comorbidities.
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Affiliation(s)
- Andrea Porzionato
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padua, Italy
| | - Aron Emmi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padua, Italy
| | - Elena Stocco
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padua, Italy
| | - Silvia Barbon
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padua, Italy
| | - Rafael Boscolo-Berto
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padua, Italy
| | - Veronica Macchi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padua, Italy
| | - Raffaele De Caro
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padua, Italy
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Fenrich M, Mrdenovic S, Balog M, Tomic S, Zjalic M, Roncevic A, Mandic D, Debeljak Z, Heffer M. SARS-CoV-2 Dissemination Through Peripheral Nerves Explains Multiple Organ Injury. Front Cell Neurosci 2020; 14:229. [PMID: 32848621 PMCID: PMC7419602 DOI: 10.3389/fncel.2020.00229] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease (CoVID-19), caused by recently identified severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), is characterized by inconsistent clinical presentations. While many infected individuals remain asymptomatic or show mild respiratory symptoms, others develop severe pneumonia or even respiratory distress syndrome. SARS-CoV-2 is reported to be able to infect the lungs, the intestines, blood vessels, the bile ducts, the conjunctiva, macrophages, T lymphocytes, the heart, liver, kidneys, and brain. More than a third of cases displayed neurological involvement, and many severely ill patients developed multiple organ infection and injury. However, less than 1% of patients had a detectable level of SARS-CoV-2 in the blood, raising a question of how the virus spreads throughout the body. We propose that nerve terminals in the orofacial mucosa, eyes, and olfactory neuroepithelium act as entry points for the brain invasion, allowing SARS-CoV-2 to infect the brainstem. By exploiting the subcellular membrane compartments of infected cells, a feature common to all coronaviruses, SARS-CoV-2 is capable to disseminate from the brain to periphery via vesicular axonal transport and passive diffusion through axonal endoplasmic reticula, causing multiple organ injury independently of an underlying respiratory infection. The proposed model clarifies a wide range of clinically observed phenomena in CoVID-19 patients, such as neurological symptoms unassociated with lung pathology, protracted presence of the virus in samples obtained from recovered patients, exaggerated immune response, and multiple organ failure in severe cases with variable course and dynamics of the disease. We believe that this model can provide novel insights into CoVID-19 and its long-term sequelae, and establish a framework for further research.
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Affiliation(s)
- Matija Fenrich
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Stefan Mrdenovic
- Department of Hematology, Clinic of Internal Medicine, University Hospital Osijek, Osijek, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marta Balog
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Svetlana Tomic
- Clinic of Neurology, University Hospital Osijek, Osijek, Croatia
- Department of Neurology and Neurosurgery, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Milorad Zjalic
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Alen Roncevic
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dario Mandic
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Clinical Institute of Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
| | - Zeljko Debeljak
- Clinical Institute of Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marija Heffer
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Payus AO, Lin CLS, Noh MM, Jeffree MS, Ali RA. SARS-CoV-2 infection of the nervous system: A review of the literature on neurological involvement in novel coronavirus disease-(COVID-19). Bosn J Basic Med Sci 2020; 20:283-292. [PMID: 32530389 PMCID: PMC7416180 DOI: 10.17305/bjbms.2020.4860] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/30/2020] [Indexed: 12/16/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is believed to have emerged from an animal source and has been spreading rapidly among humans. Recent evidence shows that SARS-CoV-2 exhibits neurotropic properties and causes neurological diseases. Here, we review the literature on neurological involvement in SARS-CoV-2 infections and the possible mechanisms of invasion of the nervous system by this virus, to provide a summary and critical analysis of the early reporting of neurological involvement in COVID-19. An exhaustive search of scientific articles on neurological involvement in COVID-19 was performed in the Web of Science, Scopus, Medline/PubMed, and several other databases. Nineteen relevant articles that had been published or were in preprint were carefully selected according to the inclusion and exclusion criteria. Based on our research, we found that patients with COVID-19 can present with neurological symptoms that can be broadly divided into central nervous system involvement, such as headache, dizziness, altered mental state, and disorientation, and peripheral nervous system involvement, such as anosmia and hypogeusia. Most of these patients are in the older age group and exhibit comorbidities, especially hypertension, and severe infection. In extreme presentations of COVID-19, some patients exhibit seizures, stroke, flaccid paraparesis, corticospinal weakness, and even coma. Moreover, the neurological man-ifestations can occur independently of the respiratory system. In conclusion, SARS-CoV-2 infection can cause multiple neurological syndromes in a more complex presentation. Therefore, this review elucidated the involvement of the nervous system in SARS-CoV-2 infection and will hopefully help improve the management of COVID-19.
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Affiliation(s)
- Alvin Oliver Payus
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Kota Kinabalu, Sabah, Malaysia
| | - Constance Liew Sat Lin
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Kota Kinabalu, Sabah, Malaysia
| | - Malehah Mohd Noh
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Kota Kinabalu, Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Kota Kinabalu, Sabah, Malaysia
| | - Raymond Azman Ali
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
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177
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Benger M, Williams O, Siddiqui J, Sztriha L. Intracerebral haemorrhage and COVID-19: Clinical characteristics from a case series. Brain Behav Immun 2020; 88:940-944. [PMID: 32525049 PMCID: PMC7276127 DOI: 10.1016/j.bbi.2020.06.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022] Open
Abstract
•We demonstrate five consecutive cases of predominantly lobar COVID-19-associated intracerebral haemorrhage (ICH). •Patients were typically relatively young with a severe, prolonged inflammatory prodrome. •COVID-19-induced endotheliitis/endotheliopathy may underlie associated cerebrovascular events. •For the clinician, anticoagulation decisions must balance risk of thrombosis with risk of haemorrhage.
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Affiliation(s)
- Matthew Benger
- Department of Neurology, King's College Hospital, London, United Kingdom.
| | - Owain Williams
- Department of Neurology, King's College Hospital, London, United Kingdom
| | - Juveria Siddiqui
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
| | - Laszlo Sztriha
- Department of Neurology, King's College Hospital, London, United Kingdom.
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178
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Abboud H, Abboud FZ, Kharbouch H, Arkha Y, El Abbadi N, El Ouahabi A. COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous System. World Neurosurg 2020; 140:49-53. [PMID: 32474093 PMCID: PMC7255736 DOI: 10.1016/j.wneu.2020.05.193] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-Cov-2, resulting in severe acute respiratory syndrome, with high potential of spreading and infecting humans worldwide. Since December 2019, when the virus was identified in humans, the literature on COVID-19 has grown exponentially and extrarespiratory symptoms including neurologic symptoms are increasingly highlighted. METHODS Given the high and increasing number of publications reporting neurologic involvements of SARS-Cov-2, we thought that providing an update for neurologic complications of COVID-19 would be useful for physicians and especially young trainees in neurology and neurosurgery. Indeed, in this review we discuss several neurologic aspects reported in the literature to date including the evidence and pathways of neuroinvasion in COVID-19 and the main neurologic disorders reported in the literature to date, as well as future perspectives and the potential long-term consequence of current neuroinfection in COVID-19 patients. RESULTS Currently, there is convincing evidence that SARS-CoV-2, the etiologic agent of COVID-19, can affect the nervous system, with damage and neurologic alterations. These neurologic disorders are grouped into several categories, ranging from nonspecific and moderate symptoms such as headache, myalgia, and hyposmia to severe symptoms including cerebrovascular disease and intracranial infections. Severe neurologic symptoms such as acute cerebrovascular disease occur only in a minority of patients with usual risk factors and are associated with poor outcome. However, most COVID-19 patients exhibit only minor or mild neurologic symptoms. CONCLUSIONS Management of COVID-19 patients should include early clinical, radiologic, and laboratory neurologic assessment, with a close follow-up, especially in severe forms. Future studies should assess late and long-term consequences of current COVID-19 patients with neurologic involvement.
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Affiliation(s)
- Hilal Abboud
- Department of Neurosurgery, Mohamed V University Hospital, Rabat, Morocco.
| | - Fatima Zahra Abboud
- Department of Radiotherapy and Neuro-oncology, Hassan II University Hospital, Fez, Morocco
| | - Hanane Kharbouch
- Department of Cardiovascular Diseases, Mohamed V University Hospital, Rabat, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, Mohamed V University Hospital, Rabat, Morocco
| | - Najia El Abbadi
- Department of Neurosurgery, Abulcasis University Hospital, Rabat, Morocco
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179
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Elmashala A, Chopra S, Garg A. The Neurologic Manifestations of Coronavirus Disease 2019. JOURNAL OF NEUROLOGY RESEARCH 2020; 10:107-112. [PMID: 33984103 PMCID: PMC8040454 DOI: 10.14740/jnr603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has so far affected 216 countries and more than 5 million individuals worldwide. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While pulmonary manifestations are the most common, neurological features are increasingly being recognized as common manifestations of the COVID-19, especially in the cases of severe infection. These include acute cerebrovascular disease, encephalitis, and Guillain-Barre syndrome (GBS). Here, we review the neuropathogenesis of SARS-CoV-2 and the central and peripheral nervous system manifestations of COVID-19.
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Affiliation(s)
- Amjad Elmashala
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Saurav Chopra
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Aayushi Garg
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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180
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Abolghasemi S, Mardani M, Sali S, Honarvar N, Baziboroun M. COVID-19 and kidney transplant recipients. Transpl Infect Dis 2020; 22:e13413. [PMID: 32677721 PMCID: PMC7404434 DOI: 10.1111/tid.13413] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022]
Abstract
Background The novel coronavirus has become a global threat and healthcare concern. The manifestations of COVID‐19 pneumonia in transplant patients are not well understood and may have more severe symptoms, longer duration, and a worse prognosis than in immunocompetent populations. Aims This study proposed to evaluate the clinical characteristics of COVID‐19 pneumonia in kidney transplant recipients. Patients/Methods Clinical records, laboratory results, radiological characteristics, and clinical outcome of 24 kidney transplant patients with COVID‐19 pneumonia were evaluated from March 20, 2020, to May 20, 2020. Results The most common symptom was shortness of breath (70.8%), followed by fever (62.5%) and cough (45.8%). Five patients had leukopenia, and only one patient had leukocytosis, while 75% of the patients had a white blood cell (WBC) count in the normal range, and 79% of recipients developed lymphopenia. All of the patients had an elevated concentration of C‐reactive protein and an increase in blood urea levels. Chest CT images of 23 patients (95.8%) showed typical findings of patchy ground‐glass shadows in the lungs. Of the 24 patients, 12 were admitted to ICU (invasive care unit), and ten of 24 patients (41.6%) died, and 14 patients were discharged after complete recovery. Conclusion It seems that COVID‐19 is more severe in transplant patients and has poorer outcomes. Multiple underlying diseases, low O2 saturation, and multilobar view in chest CT scan may be of prognostic value. However, many SARS‐CoV‐2 demonstrations are similar to those of the general population.
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Affiliation(s)
- Sara Abolghasemi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnaz Sali
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Honarvar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mana Baziboroun
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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181
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D'Amore F, Vinacci G, Agosti E, Cariddi LP, Terrana AV, Vizzari FA, Mauri M, Giorgianni A. Pressing Issues in COVID-19: Probable Cause to Seize SARS-CoV-2 for Its Preferential Involvement of Posterior Circulation Manifesting as Severe Posterior Reversible Encephalopathy Syndrome and Posterior Strokes. AJNR Am J Neuroradiol 2020; 41:1800-1803. [PMID: 32732268 DOI: 10.3174/ajnr.a6679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Since December 2019, a novel Severe Acute Respiratory Syndrome coronavirus 2 from China has rapidly spread worldwide. Although respiratory involvement is the mainstay of coronavirus disease 2019 (COVID-19), systemic involvement has recently drawn more attention. In particular, a number of recent articles have shed light on the nervous system as one of the possible targets. At our institution, we observed 15 patients with acute brain vascular manifestations; most interesting, we had a higher prevalence of the posterior circulation acute impairment. In our series, 7 patients had acute posterior cerebral injury: 1, hemorrhagic posterior reversible encephalopathy syndrome; 5, posterior circulation ischemic stroke; and 1, parieto-occipital hemorrhagic stroke. On the basis of our evidence and previous basic science reports, we believe a common etiopathogenetic thread may connect ischemic/hemorrhagic events of the posterior circulation and posterior reversible encephalopathy syndrome in the setting of COVID-19.
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Affiliation(s)
- F D'Amore
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
| | | | - E Agosti
- Neurosurgery (E.A.), University of Insubria, Hospital of Circolo and Macchi Foundation, Varese, Lombardia, Italy
| | - L P Cariddi
- Neurology and Stroke Unit (L.P.C., M.M.), Hospital of Circolo and Macchi Foundation, Varese, Lombardia, Italy.,Clinical and Experimental Medical Humanities (L.P.C.), Center of Research in Medical Pharmacology, Univeristy of Insubria, Varese, Italy
| | - A V Terrana
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
| | - F A Vizzari
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
| | - M Mauri
- Neurology and Stroke Unit (L.P.C., M.M.), Hospital of Circolo and Macchi Foundation, Varese, Lombardia, Italy
| | - A Giorgianni
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
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182
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Khan S, Gomes J. Neuropathogenesis of SARS-CoV-2 infection. eLife 2020; 9:59136. [PMID: 32729463 PMCID: PMC7392602 DOI: 10.7554/elife.59136] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic caused by the SARS-CoV-2 has recently emerged as a serious jolt to human life and economy. Initial knowledge established pulmonary complications as the chief symptom, however, the neurological aspect of the disease is also becoming increasingly evident. Emerging reports of encephalopathies and similar ailments with the detection of the virus in the CSF has elicited an urgent need for investigating the possibility of neuroinvasiveness of the virus, which cannot be ruled out given the expression of low levels of ACE2 receptors in the brain. Sensory impairments of the olfactory and gustatory systems have also been reported in a large proportion of the cases, indicating the involvement of the peripheral nervous system. Hence, the possibility of neurological damage caused by the virus demands immediate attention and investigation of the mechanisms involved, so as to customize the treatment of patients presenting with neurological complications.
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Affiliation(s)
- Shumayila Khan
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - James Gomes
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi, India
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183
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Mardani M, Nadji SA, Sarhangipor KA, Sharifi-Razavi A, Baziboroun M. COVID-19 infection recurrence presenting with meningoencephalitis. New Microbes New Infect 2020; 37:100732. [PMID: 32789020 PMCID: PMC7376341 DOI: 10.1016/j.nmni.2020.100732] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/10/2020] [Accepted: 07/17/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) infection can involve many organs, such as central nervous system, including in relapse. We describe the case of a 64-year-old woman with microbiologically confirmed COVID-19–induced respiratory distress whose treatment resulted in a negative nasopharyngeal swab reverse transcriptase PCR (RT-PCR) result for COVID-19. However, after a few weeks, relapse occurred, as indicated by symptoms of acute meningoencephalitis. Results of COVID-19 RT-PCR testing from her cerebrospinal fluid, nasopharyngeal and tracheal aspiration specimens became positive again, but COVID-19 serum antibodies were negative. We therefore note that symptoms with neurologic involvement can be one of COVID-19's first presentations, or they can appear at relapse. Regular evaluation of patients during convalescence is therefore necessary.
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Affiliation(s)
- M Mardani
- Infectious Disease and Tropical Medicine Research Center, Iran
| | - S Alireza Nadji
- Virology Research Center, National Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Iran
| | | | - A Sharifi-Razavi
- Clinical Research Development Unit of Bou-Ali Sina Hospital, Mazandarn University of Medical Science, Sari, Iran
| | - M Baziboroun
- Infectious Disease and Tropical Medicine Research Center, Iran
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184
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Thu SS, Matin N, Levine SR. Olfactory gyrus intracerebral hemorrhage in a patient with COVID-19 infection. J Clin Neurosci 2020; 79:275-276. [PMID: 33070912 PMCID: PMC7377802 DOI: 10.1016/j.jocn.2020.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/13/2020] [Indexed: 01/22/2023]
Abstract
Since the outbreak with novel corona virus in December 2019, a myriad of different neurological manifestations in patients with COVID-19 infection have been reported. We present a case of non-traumatic intracranial hemorrhage in the olfactory gyrus in a patient who tested positive for SARS-COV-2. The area of hemorrhage is not a common location for spontaneous hemorrhage. Given that loss of smell is considered a relatively common symptom of this pandemic, it is an intriguing association of COVID-19 and olfactory gyrus ICH for neurotropism of SARS-CoV2 for olfactory bulb and glia cells through nasal mucosa. Future studies will need to elucidate the exact mechanism of anosmia from COVID-19 and potential mechanisms leading to ICH.
Since the outbreak with novel corona virus in December 2019, a myriad of different neurological manifestations in patients with COVID-19 infection have been reported. We present a case of non-traumatic intracranial hemorrhage in the olfactory gyrus in a patient who tested positive for SARS-COV-2. The area of hemorrhage is not a common location for spontaneous hemorrhage. Given that loss of smell is considered a relatively common symptom of this pandemic, it is an intriguing association of COVID-19 and olfactory gyrus ICH for neurotropism of SARS-CoV2 for olfactory bulb and glia cells through nasal mucosa. Future studies will need to elucidate the exact mechanism of anosmia from COVID-19 and potential mechanisms leading to ICH.
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Affiliation(s)
- Sai Si Thu
- Departments of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States.
| | - Nassim Matin
- Departments of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States
| | - Steven R Levine
- Departments of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States.
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185
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Taherifard E, Taherifard E. Neurological complications of COVID-19: a systematic review. Neurol Res 2020; 42:905-912. [DOI: 10.1080/01616412.2020.1796405] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ehsan Taherifard
- Department of Medicine , Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Taherifard
- Department of Medicine , Shiraz University of Medical Sciences, Shiraz, Iran
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186
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Spence JD, de Freitas GR, Pettigrew LC, Ay H, Liebeskind DS, Kase CS, Del Brutto OH, Hankey GJ, Venketasubramanian N. Mechanisms of Stroke in COVID-19. Cerebrovasc Dis 2020; 49:451-458. [PMID: 32690850 PMCID: PMC7445374 DOI: 10.1159/000509581] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada,
| | - Gabriel R de Freitas
- Department of Neurology, Universidade Federal Fluminense and Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - L Creed Pettigrew
- Department of Neurology, University of Kentucky School of Medicine, Lexington, Kentucky, USA
| | - Hakan Ay
- Department of Neurology and Radiology, Harvard School of Medicine and Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, California, USA
| | - Carlos S Kase
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | | | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Washington, Australia
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187
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Abstract
Based on the available publications, the article systematizes the forms of damage to the central nervous system in СOVID-19patients. Along with a description of clinical manifestations, pathogenesis, methods of laboratory, instrumental and radiological diagnosis with the discussion of the nosological forms. An interdisciplinary approach and international cooperation are required to study the problems pathogenesis, course, outcomes, and the development of new methods of diagnosis and treatment.
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188
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Vanamoorthy P, Singh GP, Bidkar PU, Mitra R, Sriganesh K, Chavali S, Muthuchellapan R, Keshavan VH, Anand S, Goyal K, Yadav R, Rath GP, Srivastava S. The Neurocritical Care Society of India (NCSI) and the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) Joint Position Statement and Advisory on the Practice of Neurocritical Care during the COVID-19 Pandemic. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1714648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractThe COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has rapidly spread across the world including India. Management of patients complicated with neurological illness requiring neurocritical care is challenging during this time. Patients with neurological disease may develop COVID-19 infection or there could be independent neurological manifestations of COVID-19. Critically ill neurological patients are more vulnerable to contracting SARS-CoV-2 infection. Also, neurological patients with comorbidities and multisystem involvement are at increased risk of adverse outcomes. Though SARS-CoV-2 predominantly affects the pulmonary system, it can complicate the assessment and management of neurological patients. With increasing COVID-19 numbers, the hospitalizations of both non-COVID and COVID-19 neurological patients will bring significant strain on the hospital and neurocritical care facilities. Streamlining work pattern, understanding the pathophysiology of COVID-19 and its impact on neurological function, establishing general and specific neurocritical care management strategies, ensuring protection and well-being of health care providers, and implementing effective infection control policies are key elements of efficient neurocritical care management during this pandemic. This joint position statement and advisory on the practice of neurocritical care during the COVID-19 pandemic by the Neurocritical Care Society of India and the Indian Society of Neuroanaesthesiology and Critical Care has been developed to guide clinicians providing care to the critically ill neurological patients in the neurocritical care unit during the current pandemic. As the situation from this novel disease is rapidly evolving, readers must constantly update themselves with newly emerging evidence to provide the best possible care to the critically ill neurological patients.
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Affiliation(s)
- Ponniah Vanamoorthy
- Department of Neuroanaesthesiology and Neurocritical Care, Institute of Neurosciences and Spinal Disorders, MGM Healthcare, Chennai, Tamil Nadu, India
| | - Gyaninder P. Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Prasanna U. Bidkar
- Division of Neuroanaesthesiology, Department of Anesthesiology and Critical care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ranadhir Mitra
- Department of Neuroanesthesia and Neurocritical Care, Care Hospital, Bhubaneswar, Odisha, India
| | - Kamath Sriganesh
- Department of Neuroanaesthesiology and Neurocritical Care, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Siddharth Chavali
- Department of Neurosciences, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Radhakrishnan Muthuchellapan
- Department of Neuroanaesthesiology and Neurocritical Care, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Venkatesh H. Keshavan
- Department of Neuroanaesthesiology and Neurocritical Care, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Saurabh Anand
- Department of Neuroanaesthesia and Neurocritical Care, Artemis Hospital, Gurugram, Haryana, India
| | - Keshav Goyal
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Srivastava
- Department of Anesthesiology and Critical Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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189
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Nepal G, Rehrig JH, Shrestha GS, Shing YK, Yadav JK, Ojha R, Pokhrel G, Tu ZL, Huang DY. Neurological manifestations of COVID-19: a systematic review. Crit Care 2020; 24:421. [PMID: 32660520 PMCID: PMC7356133 DOI: 10.1186/s13054-020-03121-z] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global spread of coronavirus disease (COVID-19). Our understanding of the impact this virus has on the nervous system is limited. Our review aims to inform and improve decision-making among the physicians treating COVID-19 by presenting a systematic analysis of the neurological manifestations experienced within these patients. METHODS Any study, released prior to May 20, 2020, that reported neurological manifestations in patients infected by SARS-CoV-2 was systematically reviewed using the PRISMA (Preferred Reporting Items for Systemic review and Meta-Analysis) statement. RESULTS Our systematic review included data from 37 articles: twelve retrospective studies, two prospective studies, and the rest case reports/series. The most commonly reported neurological manifestations of COVID-19 were myalgia, headache, altered sensorium, hyposmia, and hypogeusia. Uncommonly, COVID-19 can also present with central nervous system manifestations such as ischemic stroke, intracerebral hemorrhage, encephalo-myelitis, and acute myelitis, peripheral nervous manifestations such as Guillain-Barré syndrome and Bell's palsy, and skeletal muscle manifestations such as rhabdomyolysis. CONCLUSION While COVID-19 typically presents as a self-limiting respiratory disease, it has been reported in up to 20% of patients to progress to severe illness with multi-organ involvement. The neurological manifestations of COVID-19 are not uncommon, but our study found most resolve with treatment of the underlying infection. Although the timeliness of this review engages current challenges posed by the COVID-19 pandemic, readers must not ignore the limitations and biases intrinsic to an early investigation.
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Affiliation(s)
- Gaurav Nepal
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | | | | | - Yow Ka Shing
- National University Hospital, Singapore, Singapore
| | - Jayant Kumar Yadav
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Zhi Lan Tu
- Department of Neurology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Dong Ya Huang
- Department of Neurology, Shanghai East Hospital of Tongji University School of Medicine, Shanghai, China
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190
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Karimi N, Sedaghat Z. Letter to the editor. Concerning the article entitled ''Guillain Barre syndrome associated with COVID-19 infection: A case report". J Clin Neurosci 2020; 79:257-258. [PMID: 33070907 PMCID: PMC7334935 DOI: 10.1016/j.jocn.2020.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 12/23/2022]
Abstract
A novel coronavirus (COVID-19) was detected in Wuhan City, Hubei Province of China. The most symptoms of disease have reported fever, cough, dyspnea, myalgia, headache, and diarrhea. We followed up GBS symptoms in one infected patient with COVID-19. The limbs weakness of patient completely improved after treatment with IVIG.
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Affiliation(s)
- Narges Karimi
- Immunogenetics Research Center, Clinical Research Development Unit of Bou Ali Sina Hospital, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Zahra Sedaghat
- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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191
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Maramattom BV, Bhattacharjee S. Neurological Complications with COVID-19: A Contemporaneous Review. Ann Indian Acad Neurol 2020; 23:468-476. [PMID: 33223662 PMCID: PMC7657269 DOI: 10.4103/aian.aian_596_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is raging across the world, affecting 212 Countries and Territories around the world. It has infected more than 3.7 million people with a mortality rate of around 7%. Although the causative virus, the SARS-CoV-2 is primarily a respiratory pathogen, recent observational studies have documented a high rate of neurological complications associated with COVID-19. We searched PubMed databases from December 01, 2019 to June 9, 2020 for articles published on "COVID 19" OR "coronavirus" with targeted search words. We also search preprint servers for neurological complications of COVID-19. Neurological manifestations are seen in around 36%-45% of patients with COVID-19 and can involve almost every part of the central nervous system (CNS) from the hemispheres, cranial or peripheral nerves, spinal cord, and muscle. The mechanisms vary from direct viral invasion of the CNS, to a dysregulated host immune response to molecular mimicry to multiorgan dysfunction. In many patients, neurological manifestations preceded other systemic features or the diagnosis of COVID-19. Sick patients with COVID-19 will require ICU care and many patients may present first to the neurocritical care ICU and receive a diagnosis of COVID-19 later. Hence, it is important for all healthcare personnel to be aware of the myriad neurological manifestations of this infection, so as to initiate appropriate infection control practices and refine investigation and treatment protocols.
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Affiliation(s)
- Boby Varkey Maramattom
- Department of Neurology & Critical Care Neurology, Kochi, Kerala, India
- Department of Internal Medicine, Aster Medcity, Kochi, Kerala, India
| | - Siddharth Bhattacharjee
- Department of Neurology & Critical Care Neurology, Kochi, Kerala, India
- Department of Internal Medicine, Aster Medcity, Kochi, Kerala, India
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192
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Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci 2020; 41:1667-1671. [PMID: 32483687 PMCID: PMC7262683 DOI: 10.1007/s10072-020-04486-3] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2020] [Indexed: 12/28/2022]
Abstract
RESULTS Various neurological manifestations have been reported in the literature associated with COVID-19, which in the current study are classified into Central Nervous System (CNS) related manifestations including headache, dizziness, impaired consciousness, acute cerebrovascular disease, epilepsy, and Peripheral Nervous System (PNS) related manifestations such as hyposmia/anosmia, hypogeusia/ageusia, muscle pain, and Guillain-Barre syndrome. CONCLUSION During the current context of COVID-19 pandemic, physicians should be aware of wide spectrum of neurological COVID-19 sign and symptoms for early diagnosis and isolation of patients. In this regard, COVID-19 has been associated with many neurological manifestations such as confusion, anosmia, and ageusia. Also, various evidences support the possible CNS roles in the COVID-19 pathophysiology. In this regard, further investigation of CNS involvement of SARS-COV-2 is suggested.
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Affiliation(s)
- Hamid Reza Niazkar
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Behdad Zibaee
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali Nasimi
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Narjes Bahri
- Department of Midwifery, Faculty of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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193
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Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, Bolling MC, Dijkstra G, Voors AA, Osterhaus AD, van der Voort PH, Mulder DJ, van Goor H. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol 2020; 251:228-248. [PMID: 32418199 PMCID: PMC7276767 DOI: 10.1002/path.5471] [Citation(s) in RCA: 669] [Impact Index Per Article: 167.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
Angiotensin-converting enzyme 2 (ACE2) has been established as the functional host receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the current devastating worldwide pandemic of coronavirus disease 2019 (COVID-19). ACE2 is abundantly expressed in a variety of cells residing in many different human organs. In human physiology, ACE2 is a pivotal counter-regulatory enzyme to ACE by the breakdown of angiotensin II, the central player in the renin-angiotensin-aldosterone system (RAAS) and the main substrate of ACE2. Many factors have been associated with both altered ACE2 expression and COVID-19 severity and progression, including age, sex, ethnicity, medication, and several co-morbidities, such as cardiovascular disease and metabolic syndrome. Although ACE2 is widely distributed in various human tissues and many of its determinants have been well recognised, ACE2-expressing organs do not equally participate in COVID-19 pathophysiology, implying that other mechanisms are involved in orchestrating cellular infection resulting in tissue damage. Reports of pathologic findings in tissue specimens of COVID-19 patients are rapidly emerging and confirm the established role of ACE2 expression and activity in disease pathogenesis. Identifying pathologic changes caused by SARS-CoV-2 infection is crucially important as it has major implications for understanding COVID-19 pathophysiology and the development of evidence-based treatment strategies. Currently, many interventional strategies are being explored in ongoing clinical trials, encompassing many drug classes and strategies, including antiviral drugs, biological response modifiers, and RAAS inhibitors. Ultimately, prevention is key to combat COVID-19 and appropriate measures are being taken accordingly, including development of effective vaccines. In this review, we describe the role of ACE2 in COVID-19 pathophysiology, including factors influencing ACE2 expression and activity in relation to COVID-19 severity. In addition, we discuss the relevant pathological changes resulting from SARS-CoV-2 infection. Finally, we highlight a selection of potential treatment modalities for COVID-19. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Arno R Bourgonje
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Amaal E Abdulle
- Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke C Bolling
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albert Dme Osterhaus
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
| | - Peter Hj van der Voort
- Department of Critical Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Douwe J Mulder
- Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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194
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Saavedra JM. COVID-19, Angiotensin Receptor Blockers, and the Brain. Cell Mol Neurobiol 2020; 40:667-674. [PMID: 32385549 PMCID: PMC7207082 DOI: 10.1007/s10571-020-00861-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Juan M Saavedra
- Department of Pharmacology and Physiology, Georgetown University Medical Center, 3900 Reservoir Road, NW, Washington, DC, 20057, USA.
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195
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Fremed MA, Lytrivi ID, Liberman L, Anderson BR, Barry OM, Choudhury TA, Chrisomalis-Dring S, Ferris A, Glickstein JS, Krishnan U, Levasseur S, Rosenzweig EB, Shah A, Silver ES, Suh S, Turner ME, Weller R, Woo J, Starc TJ. Cardiac workup and monitoring in hospitalised children with COVID- 19. Cardiol Young 2020; 30:907-910. [PMID: 32611457 PMCID: PMC8717675 DOI: 10.1017/s1047951120001778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
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Affiliation(s)
- Michael A Fremed
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Irene D Lytrivi
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett R Anderson
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Oliver M Barry
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarif A Choudhury
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Anne Ferris
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie S Glickstein
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Usha Krishnan
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stéphanie Levasseur
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amee Shah
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sanghee Suh
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mariel E Turner
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Weller
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joyce Woo
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Thomas J Starc
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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196
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Azim D, Nasim S, Kumar S, Hussain A, Patel S. Neurological Consequences of 2019-nCoV Infection: A Comprehensive Literature Review. Cureus 2020; 12:e8790. [PMID: 32601577 PMCID: PMC7317136 DOI: 10.7759/cureus.8790] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
First identified in November 2019 in Hubei Province, the coronavirus disease of 2019 (COVID-19) caused by SARS-CoV-2 soon spread worldwide to become a global health pandemic. The COVID-19 preferentially damages the respiratory system that produces symptoms such as fever, cough, and shortness of breath. However, the infection often tends to disseminate to involve various organ systems. Recent evidence indicates that SARS-CoV-2 can cause significant neurological damage and resultant neurological symptoms and complications. Here, we provide a comprehensive and thorough review of original articles, case reports, and case series to delineate the possible mechanisms of nervous system invasion and damage by SARS-CoV-2 and subsequent consequences. We divided the neurological manifestations into three categories: (1) Central Nervous System involvement, (2) Peripheral Nervous System manifestations, and (3) Skeletal Muscle Injury. Headache and dizziness were found to be the most prevalent symptoms followed by impaired consciousness. Among the symptoms indicating peripheral nervous system invasion, anosmia and dysgeusia were commonly reported. Skeletal muscle injury predominantly presents as myalgia. In addition, encephalitis, myelitis, cerebrovascular disease, Guillain-Barre syndrome, and Miller Fischer syndrome were among the commonly noted complications. We also emphasized the association of pre-existing comorbidities with neurological manifestations. The aim of this review is to provide a deeper understanding of the potential neurological implications to help neurologists have a high index of clinical suspicion allowing them to manage the patient appropriately.
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Affiliation(s)
- Dua Azim
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sundus Nasim
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sohail Kumar
- Internal Medicine, Dow Medical College and Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Azhar Hussain
- Healthcare Administration, Franklin University, Columbus, USA
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Sundip Patel
- Medicine, Windsor University School of Medicine, Cayon, KNA
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197
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Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol 2020; 267:3135-3153. [PMID: 32561990 PMCID: PMC7304377 DOI: 10.1007/s00415-020-09990-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
Background In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Objective To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. Methods We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. Results We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. Conclusions Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain–Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic. Electronic supplementary material The online version of this article (10.1007/s00415-020-09990-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malik Ghannam
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
| | - Qasem Alshaer
- Department of Neurology, Emory University, Atlanta, GA USA
| | | | - Lara Zakarna
- Department of Neuroscience, An-Najah National University, Nablus, Palestine
| | - Jetter Robertson
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
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198
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The "Three Italy" of the COVID-19 epidemic and the possible involvement of SARS-CoV-2 in triggering complications other than pneumonia. J Neurovirol 2020; 26:311-323. [PMID: 32548750 PMCID: PMC7297137 DOI: 10.1007/s13365-020-00862-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19), first reported in Wuhan, the capital of Hubei, China, has been associated to a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In March 2020, the World Health Organization declared the SARS-CoV-2 infection a global pandemic. Soon after, the number of cases soared dramatically, spreading across China and worldwide. Italy has had 12,462 confirmed cases according to the Italian National Institute of Health (ISS) as of March 11, and after the “lockdown” of the entire territory, by May 4, 209,254 cases of COVID-19 and 26,892 associated deaths have been reported. We performed a review to describe, in particular, the origin and the diffusion of COVID-19 in Italy, underlying how the geographical circulation has been heterogeneous and the importance of pathophysiology in the involvement of cardiovascular and neurological clinical manifestations.
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199
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Coolen T, Lolli V, Sadeghi N, Rovai A, Trotta N, Taccone FS, Creteur J, Henrard S, Goffard JC, Dewitte O, Naeije G, Goldman S, De Tiège X. Early postmortem brain MRI findings in COVID-19 non-survivors. Neurology 2020; 95:e2016-e2027. [PMID: 32546654 DOI: 10.1212/wnl.0000000000010116] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuroinvasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. METHODS In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest CT scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility. RESULTS Among the 62 patients who died of COVID-19 from March 31, 2020, to April 24, 2020, at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical microbleeds and macrobleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES; 1 decedent), and nonspecific deep white matter changes (1 decedent). Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed. CONCLUSIONS Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.
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Affiliation(s)
- Tim Coolen
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Valentina Lolli
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Niloufar Sadeghi
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Antonin Rovai
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Nicola Trotta
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Jacques Creteur
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Sophie Henrard
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Jean-Christophe Goffard
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Olivier Dewitte
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Gilles Naeije
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Xavier De Tiège
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium.
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Wang H, Tang X, Fan H, Luo Y, Song Y, Xu Y, Chen Y. Potential mechanisms of hemorrhagic stroke in elderly COVID-19 patients. Aging (Albany NY) 2020; 12:10022-10034. [PMID: 32527987 PMCID: PMC7346040 DOI: 10.18632/aging.103335] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/14/2020] [Indexed: 04/11/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019, a new human infectious disease. While fever, cough, and respiratory distress are typical first symptoms, a fraction of those affected present instead with neurological symptoms suggestive of central nervous system compromise. This review summarizes the potential contribution of coronavirus disease 2019 to hemorrhagic stroke in the elderly and proposes possible mechanisms. Reports show that the most affected patients have underlying chronic diseases such as hypertension and diabetes, which are two key risk factors for hemorrhagic stroke. Angiotensin-converting enzyme 2 is the main host cell surface receptor interacting with the severe acute respiratory syndrome coronavirus 2 spike glycoprotein to allow viral entry and infection. We speculate that ensuing downregulation of angiotensin-converting enzyme 2 expression may compound the risk conferred by pre-existing comorbidities and critically influence the pathogenesis of hemorrhagic stroke by elevating blood pressure and impairing cerebrovascular endothelial function. Additionally, both age- and/or disease-related immune dysfunction and enhanced catecholamine release secondary to anxiety and stress may also aggravate central nervous system symptoms of severe acute respiratory syndrome coronavirus 2 infection. Thus, assessment of systemic inflammatory biomarkers and tight control of hemodynamic parameters upon admission are crucial to minimize mortality and morbidity in coronavirus disease 2019 patients with central nervous system symptoms suggestive of incipient stroke.
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Affiliation(s)
- Haili Wang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Xiaojia Tang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Hongyang Fan
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Yuhan Luo
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Yuxia Song
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Yao Xu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
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