Pathophysiological Mechanisms and Neurological Manifestations in COVID-19

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Azizullah Khan
2. Santosh Kumar Dash
3. Pandurang Reddy Mare
4. Arun Garg
5. Anil Gurnani
6. Khalid Ismail Khatib
7. Rahul Gupta
8. Atma Ram Bansal
ISSN
0972-5229
DOI
10.5005/jp-journals-10071-23592
Volume
24
Issue
10
Publishing Year
2020
Pages
6
Author Affiliations
    1. Govt. Medical College and SSG Hospital, Vadodara, Gujarat, India
    2. University of Vermont; Alice Hyde Medical Center, Malone, NY, USA
    3. Beth Israel Deaconess Hospital, Beth Israel Deaconess Medical Center; Harvard Medical School; University of Vermont, USA
    4. RMM Global Hospital Trauma Centre, Shantivan, Rajasthan, India
    5. Global Rainbow Healthcare, Agra, Uttar Pradesh, India
    6. RMM Global Hospital Trauma Center, Mount Abu, Rajasthan, India
    1. Department of Neuro Sciences, Medanta, Gurugram, Haryana, India
    1. Medanta Institute of Neurosciences, Medanta–The Medicity, Gurgaon, Haryana, India
    2. Institute of Neurosciences, Medanta – The Medicity, Gurugram, Haryana, India
    3. Medanta Institute of Neurosciences Medanta–The Medicity, Gurugram, Haryana, India
    4. Medanta Institute of Neurosciences, Medanta—The Medicity, Gurugram, Haryana, India
    1. Department of Neurology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
    1. Kailash Hospital and Heart Institute, Noida, Uttar Pradesh, India
    1. Department of Critical Care, Prince Ali Khan Hospital, Mumbai, Maharashtra, India
    1. Department of Neuro Surgery, P D Hinduja, Mumbai, Maharashtra, India
  • Article keywords
    Anosmia, Central nervous system, Coronavirus disease 2019, Encephalopathy, Headache, Stroke

    Abstract

    With increasing knowledge of the coronavirus disease 2019 (COVID-19), we now understand that COVID-19 presents with various extrapulmonary manifestations with multiorgan involvement. Involvement of the central nervous system (CNS) occurs probably via transsynaptic spread or transfer across the blood–brain barrier. Hypoxia, immune-mediated injury, and vascular damage are the potential mechanisms for the CNS manifestations. Headache, dizziness, chemosensory disturbances, such as loss of smell, taste, encephalopathy, stroke, etc., are among the commonly encountered neurological presentations. Headache is identified as one of the red flag symptoms for COVID-19. Sudden onset of loss of smell and/or taste in the absence of nasal congestion can help in COVID-19 case identification and testing prioritization. Both hemorrhagic and ischemic brain injury is common in patients developing stroke. Besides these, COVID-19-associated CNS involvement demands more careful attention toward patients with existing neurological disorders especially that are managed with immunosuppressant agents. In all, neurological involvement in COVID-19 is not uncommon and may precede, occur concomitantly or after the respiratory involvement. It may also be the sole presentation in some of the patients necessitating high vigilance for COVID-19. In this review, we briefly discussed the pathogenesis of CNS involvement and some important neurological manifestations in COVID-19.

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