COVID-19 and its impact on neurological manifestations and mental health: the present scenario
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REVIEW ARTICLE
COVID-19 and its impact on neurological manifestations and mental health: the present scenario Shehnaz Sultana 1 & Venkateshwari Ananthapur 1 Received: 31 July 2020 / Accepted: 28 August 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Though the COVID-19 pandemic primarily affects pulmonary and cardiorenal functions, many healthcare and its allied groups reported neurological involvement of SARS-CoV-2 in combination with either pre-existing metabolic abnormalities, medical conditions, infections or even chronic to acute inflammatory episodes of the nervous system. The present review provides a fair outlook of the published literature and also the case reports with an emphasis on plausible mechanisms involved in neurological complications of the central and peripheral nervous systems. Awareness on the neuropsychiatric manifestations being discussed in this article should ideally help the medical community in early identification and effective management of potentially lifethreatening neurological diseases. Keywords COVID-19 . Neurological manifestations . Cerebrovascular disease . Stroke . Cytokine storm . Stress
Introduction
Mechanism of nervous system invasion
COVID-19, a severe acute respiratory syndrome (SARS) caused by SARS-CoV-2, emerged in China and advanced into a global pandemic infecting more than 22 million people globally while causing over 793,763 deaths and counting [1]. Seventy percent of the COVID-19 patients show mild to moderate respiratory symptoms, while the rest progress into severe to fatal respiratory and systemic illnesses depending on the personal genetic makeup, extent or phase of infection and inadequate management. Historically, various strains of coronaviruses are found to have neurotropism and neuroinvasive characteristics resulting in neuro and psychological consequences in a subset of COVID-19 affected population. And majority of the deaths are due to respiratory failure which is a pathophysiological consequence of a comprised brainlung-brain axis wherein neurological dysfunction and lung injury are mutually inclusive.
Our understanding over time on this opportunistic pathogen has elucidated its prominent involvement in respiratory and its allied systems including cardiovascular and renal systems. Once in the blood stream, the SARS virus can spread into central and peripheral nervous systems through retrograde axonal transport or infection of the pericytes and astrocytes that are part of blood-brain barrier (BBB). Neuro-invasion of SARS-CoV-2 may also be via the olfactory nerve or infection of vascular endothelium or even the infected leukocyte migration across the blood-brain barrier (BBB). Once entering the CNS through the compromised BBB, SARS-CoV-2 virus disseminates progressively along the neurotransmission or haematogenous pathways such as serotonergic dorsal raphe system or the Virchow-Robin spaces, respectively. Neuroinvasive potential of SARS-CoV-2 particularly into the medullary structures including brain stem involved in the respiration m
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