Neurologic Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Avindra Nath, MD Neuroinfectious Diseases p. 1051-1065 August 2021, Vol.27, No.4 doi: 10.1212/CON.0000000000000992
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PURPOSE OF REVIEW This article describes the spectrum of neurologic complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, their underlying pathology and pathogenic mechanisms, gaps in knowledge, and current therapeutic strategies.

RECENT FINDINGS COVID-19 is the clinical syndrome caused by the novel coronavirus SARS-CoV-2. It can affect the entire neuraxis, and presentations in the acute phase are variable, although anosmia is a common manifestation. Encephalopathy is common in patients who are hospitalized and is often associated with multiorgan involvement. Immune-mediated encephalitis is probably underrecognized; however, viral encephalitis is rare. Other manifestations include stroke, seizures, myelitis, and peripheral neuropathies, including Guillain-Barré syndrome, which sometimes has atypical manifestations. Treatment is symptomatic, and immunotherapies have been used successfully in some patients. Long-term complications include dysautonomia, exercise intolerance, malaise, sleep disturbances, cognitive impairment, and mood disorders.

SUMMARY Neurologic manifestations of COVID-19 may occur in the acute setting and may be independent of respiratory manifestations. Immune-mediated syndromes and cerebrovascular complications are common. Large populations of patients are expected to have long-term neurologic complications of COVID-19, many of which may emerge only after recovery from the acute illness.

Address correspondence to Dr Avindra Nath, Bldg 10, Room 7C-103, 10 Center Dr, Bethesda, MD 20892, [email protected].

RELATIONSHIP DISCLOSURE: Dr Nath has served on the editorial board for Brain, as a section editor for Frontiers of Neurology, and as an associate editor for the Journal of Neurovirology and has received research grants from the National Institutes of Health (NS03130).

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Nath reports no disclosure.

© 2021 American Academy of Neurology.