The Neurologic Impact of COVID-19: Early Signs, Past Experience

May 20, 2020

As neurologic findings among patients with COVID-19 emerge, comparison to sequelae seen with other coronaviruses is instructive.

Since the pandemic began, research on COVID-19 has moved at a breakneck pace. Indications of COVID-19 infection as a systemic illness emerged relatively early, with accumulating evidence showing a wide range of effects on almost every organ system.

Already, a number of published reviews have described neurologic complications of COVID-19. As more data become available, knowledge and understanding of neurologic findings in COVID-19 may change. However, current comparison to similar infections like Middle East Respiratory Syndrome (MERS), influenza H1N1, and the novel severe acute respiratory syndrome coronavirus 1 (SARS-CoV1) suggests the need for early recognition of neurologic complications, as well as monitoring for neurologic sequelae over time in survivors.

SARS-CoV2/COVID-19. Presentation most commonly seen is interstitial pneumonia; evidence is growing that COVID-19 is a multisystem disease.

Primary vs Secondary Neurologic Manifestations of COVID-19. Neurologic involvement has been reported in nearly one-third of patients, both direct infection of the central and peripheral nervous systems and infection of organs which secondarily affects CNS/PNS.

Reported Neurologic Manifestations of COVID-19. Commonly reported neurologic symptoms in COVID-19 include dizziness, headache, altered consciousness; also reported: decreased taste/smell, visual impairment, ataxia.

Potential for Post-pandemic Neurologic Sequelae. Given the prevalence of neurologic after effects seen with prior coronavirus-related pandemics, there is cause for heightened attention to such findings in the coming months.

References

1. Finsterer J, Stollberger C. Update on the nuerology of COVID-19. J Med Virol. Published online May 13 2020. DOI: 10.1002/jmv.26000 https://onlinelibrary.wiley.com/doi/epdf/10.1002/jmv.26000

2. Daou BJ, Koduri S, Palmateer G, et al. Letter: Neurological implications of COVID-19 and lessons learned from prior epidemics and pandemics [published online ahead of print, 2020 May 3]. Neurosurgery. 2020;nyaa186. doi:10.1093/neuros/nyaa186