NeuroCOVID: critical review of neuropsychiatric manifestations of SARS-CoV-2 infection
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LETTER TO THE EDITOR
NeuroCOVID: critical review of neuropsychiatric manifestations of SARS-CoV-2 infection Renato Oliveira 1,2,3 & Filipa Dourado Sotero 3 & Tomás Teodoro 2,4 Received: 31 August 2020 / Accepted: 5 September 2020 # Royal Academy of Medicine in Ireland 2020
Keywords Corona virus infections . Coronavirus . COVID . Neurologic manifestations . Neuropsychiatry
Dear Editor, We read with great interest Deana C’s critical overview of emerging data amidst the novel coronavirus disease 2019 (COVID-19) pandemics about its treatment approach [1]. This is an increasingly relevant topic of discussion in all medical specialties including neurology and psychiatry. We expand the discussion here. COVID-19 greatly impacts healthcare systems on a global scale. The widespread societal consequences understandably urge researchers to share information that may contribute to our understanding of this disorder. The plethora of publications regarding SARS-CoV-2 infection initially focused on general clinical presentation but the focus widened to include specific organ involvement as well as negative mental health outcomes. Ling Mao and colleagues’ highly cited case series of hospitalized patients is an example of such efforts [2]. Recent reviews of the neurological symptoms of COVID-19 raise relevant questions regarding the quality of the scarce data emerging about neurological involvement [3]. Evidence of neurological disease associated with SARS/MERS-CoV favors the neuroinvasive potential of SARS-CoV-2 [4]. Most
* Tomás Teodoro [email protected] 1
Department of Neurology, Hospital da Luz – Lisboa, Lisbon, Portugal
2
Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
3
Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
4
Department of Psychiatry, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, 1749-002 Lisbon, Portugal
commonly reported neurological manifestations include nonspecific symptoms that may be consequence of the systemic inflammatory response rather than direct neurological involvement. In mild cases, the most consistent symptoms include hyposmia and dysgeusia probably related to SARSCoV-2 pathophysiology (olfactory neuron transport) [2]. Specific neurological findings (e.g., ataxia, seizures) and serious neurological disease have also been reported [2, 5] (Table 1). Laboratory findings are largely nonspecific and SARS-CoV-2 is yet to be detected in cerebrospinal fluid [6]. Elevated D-dimer levels in severe cases may be associated with the increased risk of stroke although this finding could simply be a marker of inflammatory response [2]. Impact of past pandemics on mental health is well established with increased risk of anxiety and depression. The worsening of psychiatric symptoms in this setting is most likely related to chronic stress although there may be contribution of either acute infection or inflammatory response [4]. Individuals may develop stres
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