The Environmental Neurology Specialty Group (ENSG) of the World Federation of Neurology (WFN) has published a report that details current understanding of the neurologic impacts of coronavirus disease 2019 (COVID-19). The report, published in the Journal of Neurological Sciences, describes various cases across the world of COVID-19 and the associated incidence of several different neurological complications, including headache, cerebrovascular disease, Guillain-Barré syndrome (GBS), and Miller Fisher syndrome.

In studies from Wuhan, China, the geographic center where cases of COVID-19 were first reported, investigators found an association between the infection and headache. Additionally, the researchers also found a substantially higher proportion of patients who experienced early alteration of consciousness or impaired consciousness because of severe disease.

Although the data did not determine whether these conditions were concurrent or if they were induced by the virus, the ENSG-WFN suggested that early onset of headache and decreased responsiveness may be indicators of possible neurologic involvement in COVID-19.

According to current evidence and real-world data, common CNS symptoms associated with COVID-19 include anosmia and dysgeusia, or the impaired ability to smell or taste normally, respectively. The presence of anosmia may be associated with the coronaviruses’ potential to invade the brain, the ENSG-WFN wrote.

Other case reports have found an association between meningitis, encephalitis, and seizures with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus strain responsible for COVID-19. In some instances, these conditions were treated successfully, and the patients were discharged. In others, particularly in elderly patients, the conditions may have complicated prognosis and led to respiratory failure.

Respiratory failure, a leading cause of mortality in COVID-19, may have a neurogenic origin, resulting in the viral invasion of cranial nerve. This may ultimately lead into the rhinencephalon and brainstem respiratory center, according to the ENSG-WFN.

Case reports have also highlighted an association between COVID-19 and the development of myelitis and myopathies. Other case reports have described associations between COVID-19 and the development of Miller Fisher syndrome, polyneuritis cranialis, and neurosensory hearing loss.

 

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Further information

G.C. Román, P.S. Spencer, J. Reis, et al., The neurology of COVID-19 revisited: A proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries, Journal of the Neurological Sciences (2020), https://doi.org/10.1016/j.jns.2020.116884