Environmental Disease

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

Coronavirus disease 2019 infection and neurological manifestations: Points to ponder


Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2,  
1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India

Abstract

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



How to cite this article:
Shrivastava SR, Shrivastava PS. Coronavirus disease 2019 infection and neurological manifestations: Points to ponder.Environ Dis 2022;7:76-79


How to cite this URL:
Shrivastava SR, Shrivastava PS. Coronavirus disease 2019 infection and neurological manifestations: Points to ponder. Environ Dis [serial online] 2022 [cited 2022 Nov 28 ];7:76-79
Available from: http://www.environmentmed.org/text.asp?2022/7/3/76/357448


Full Text



 Introduction



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

 Coronavirus Disease 2019 Pandemic and Disruption of Essential Neurological Services



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

 Coronavirus Disease 2019 Infection and Neurological Manifestations



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

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

 Post-Coronavirus Disease 2019 Neurological Sequelae



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

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

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

 Coronavirus Disease 2019 and Preexisting Neurological Conditions



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

 Neurological Complications Postvaccination



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

 Implications for Future



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

 Conclusion



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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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