COVID-19

COVID-19 Neuro

Updated Aug 29, 2020

15 APR 2020: Neurologic Features in Severe SARS-CoV-2 Infection (NEJM)“In this consecutive series of patients, ARDS due to SARS-CoV-2 infection was associated with encephalopathy, prominent agitation and confusion, and corticospinal tract signs. Two of 13 patients who underwent brain MRI had single acute ischemic strokes. Data are lacking to determine which of these features were due to critical illness–related encephalopathy, cytokines, or the effect or withdrawal of medication, and which features were specific to SARS-CoV-2 infection.”

26 MAY 2020: Loss of Smell and Taste in 2013 European Patients With Mild to Moderate COVID-19 (Annals of Internal Medicine)
“The prevalence of self-reported smell and taste dysfunction in our study is higher than previously reported and may be characterized by different clinical forms. Our results suggest that anosmia may not be related to nasal obstruction or inflammation. Future studies are needed to understand the pathophysiologic mechanisms underlying loss of smell and taste in COVID-19, including potential viral spread through the olfactory neuroepithelium and invasion of the olfactory bulb and central nervous system”

29 MAY 2020: Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID-19) and Anosmia (JAMA)
“Based on the MRI findings … we can speculate that SARS-CoV-2 might invade the brain through the olfactory pathway and cause an olfactory dysfunction of sensorineural origin; cerebrospinal fluid and pathology studies are required to confirm this hypothesis.”

29 MAY 2020: Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019 (JAMA)
“Viral neuroinvasion may be achieved by several routes, including transsynaptic transfer across infected neurons, entry via the olfactory nerve, infection of vascular endothelium, or leukocyte migration across the blood-brain barrier. The most common neurologic complaints in COVID-19 are anosmia, ageusia, and headache, but other diseases, such as stroke, impairment of consciousness, seizure, and encephalopathy, have also been reported.”

8 JUN 2020: Neurobiology of COVID-19 (Journal of Alzheimer’s Disease)
“Anosmia, stroke, paralysis, cranial nerve deficits, encephalopathy, delirium, meningitis, and seizures are some of the neurological complications in patients with coronavirus disease-19 (COVID-19)“

1 JUL 2020: Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children (JAMA Neurology)
“Of the 27 children with COVID-19 pediatric multisystem inflammatory syndrome, 4 patients (14.8%) who were previously healthy had new-onset neurological symptoms. Symptoms included encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness, and reduced reflexes … all 4 patients had signal changes in the splenium of the corpus callosum on neuroimaging and required intensive care admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome.”

2 JUL 2020: Neurological associations of COVID-19 (Lancet Neurology)
“We summarise the evidence to date for COVID-19, examine putative disease mechanisms, and finally suggest a framework for investigating patients with suspected COVID-19-associated neurological disease to support clinico-epidemiological, disease mechanism, and treatment studies.”

6 JUL 2020: High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms (medRxiv preprint)
“We report [anti-neuronal] autoantibody findings in eleven critically ill COVID-19 patients presenting with a variety of neurological symptoms with unexplained etiology.” 

8 JUL 2020: The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings (Brain)
“Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness…”
Article on paper: Dozens More Cases of Neurological Problems in COVID-19 Reported (The Scientist)

9 JUL 2020: Association of neuronal injury blood marker neurofilament light chain with mild-to-moderate COVID-19 (Journal of Neurology)
“Our results indicate for the first time that COVID-19 may affect the neuro-axonal integrity also in adults with a mild-to-moderate course of the disease. This new evidence for a more general neuro-destructive capability of SARS-CoV-2 also in mild-to-moderate COVID-19 patients should raise awareness for potential long-term neurologic sequelae following COVID-19.”

25 JUL 2020: Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study (Lancet Psychiatry)
“Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.”

3 AUG 2020: Cerebral Micro-Structural Changes in COVID-19 Patients – An MRI-based 3-month Follow-up Study (Lancet)
“COVID-19 patients had statistically significantly higher bilateral gray matter volumes (GMV) in olfactory cortices, hippocampi, insulas, left Rolandic operculum, left Heschl’s gyrus and right cingulate gyrus and a general decline of MD, AD, RD accompanied with an increase of FA in white matter, especially AD in the right CR, EC and SFF, and MD in SFF compared with non-COVID-19 volunteers” 

4 AUG 2020: SARS-CoV-2 infects human neural progenitor cells and brain organoids (Nature Letter to the Editor)
“The finding that SARS-CoV-2 can productively infect human brain organoids highlights the potential of direct viral involvement in neurological symptoms in COVID-19 patients. These results provided insight on the pathognomonic symptoms of anosmia (loss of smell) and ageusia (loss of taste) as well as other neurological manifestations of COVID-19 including seizure, encephalopathy, encephalitis, Guillain-Barre syndrome, and Miller Fisher syndrome.” 

8 AUG 2020: Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis (Journal of Neurology)
“In meta-analysis, COVID-19 patient with pre-existing CeVD had 2.67-fold (1.75–4.06) higher odds of poor outcomes.”