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Neurological Complications of the COVID-19 Pandemic: What Have We Got So Far?

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Clinical, Biological and Molecular Aspects of COVID-19

Part of the book series: Advances in Experimental Medicine and Biology ((PMISB,volume 1321))

Abstract

The recently emerged coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of COVID-19, is the newest threat to human health. It has already infected more than 54.5 million people worldwide, currently leading to more than 1.3 million deaths. Although it causes a mild flu-like disease in most patients, lethality may increase to more than 20% in elderly subjects, especially in those with comorbidities, like hypertension, diabetes, or lung and cardiac disease, and the mechanisms are still elusive. Common symptoms at the onset of illness are fever, cough, myalgia or fatigue, headache, and diarrhea or constipation. Interestingly, respiratory viruses have also placed themselves as relevant agents for central nervous system (CNS) pathologies. Conversely, SARS-CoV-2 has already been detected in the cerebrospinal fluid. Here, we discuss several clinical features related to CNS infection during COVID-19. Patients may progress from headaches and migraines to encephalitis, stroke, and seizures with leptomeningitis. However, the pathway used by the virus to reach the brain is still unknown. It may infect the olfactory bulb by retrograde neuronal transportation from olfactory epithelium, or it could be transported by the blood. Either way, neurological complications of COVID-19 add greatly to the complex pathophysiology of the disease. Neurological signs and symptoms must alert physicians not only to worst outcomes but also to future possible degenerative diseases.

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Abbreviations

ACE2:

angiotensin-converting enzyme 2

ADEM:

acute disseminated encephalomyelitis

CD147:

CD147-spike protein

CNS:

central nervous system

COVID-19:

coronavirus disease 2019

CoVs:

coronaviruses

CSF:

cerebrospinal fluid

CTSB:

cathepsin B

CTSL:

cathepsin L

DPP4:

dipeptidyl peptidase 4

ECG:

electrocardiogram

GBC:

globose basal cells

GBS:

Guillain-Barré syndrome

HBC:

horizontal basal cells

HCoV-OC43:

human coronavirus OC43

hMPV:

human metapneumovirus

hRSV:

human respiratory syncytial virus

MERS:

Middle East respiratory syndrome

MHV:

murine hepatitis virus

NIHSS:

National Institutes of Health Stroke Scale

OSN:

olfactory sensory neurons

PNS:

peripheral nervous system

RBD:

receptor-binding domain

SARS:

severe acute respiratory syndrome

SARS-CoV:

severe acute respiratory syndrome coronavirus

SARS-CoV-2:

severe acute respiratory syndrome coronavirus 2

SP or S protein:

spike proteins

STD:

smell and/or taste disorders

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Conflicts of Interest/Competing Interests

The authors report no disclosures.

Availability of Data and Material

We utilized publicly available data.

Funding

JPSP is funded by FAPESP grants #2017/26170–0 and 2017/22504–1 and CNPq (301287/2016–3). No other targeted funding is reported.

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Authors and Affiliations

  1. Department of Medicine, Universidade da Região de Joinville (UNIVILLE), Joinville, Brazil

    Isabelle Pastor Bandeira, Marco Antônio Machado Schlindwein & Leticia Caroline Breis

  2. Department of Immunology, Institute of Biomedical Sciences, University of São Paulo (ICB-USP), São Paulo, Brazil

    Jean Pierre Schatzmann Peron

  3. Scientific Platform Pasteur-USP, University of São Paulo (USP), São Paulo, SP, Brazil

    Jean Pierre Schatzmann Peron

  4. Immunopathology and Allergy Post Graduate Program, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil

    Jean Pierre Schatzmann Peron

  5. Professor of Neurology, Department of Medicine, Universidade da Região de Joinville (UNIVILLE), Joinville, Brazil

    Marcus Vinícius Magno Gonçalves

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  1. Isabelle Pastor Bandeira
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Correspondence to Jean Pierre Schatzmann Peron .

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  1. University of Campinas, São Paulo, Brazil

    Paul C. Guest

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Bandeira, I.P., Schlindwein, M.A.M., Breis, L.C., Peron, J.P.S., Gonçalves, M.V.M. (2021). Neurological Complications of the COVID-19 Pandemic: What Have We Got So Far?. In: Guest, P.C. (eds) Clinical, Biological and Molecular Aspects of COVID-19. Advances in Experimental Medicine and Biology(), vol 1321. Springer, Cham. https://doi.org/10.1007/978-3-030-59261-5_2

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