Semin Neurol 2022; 42(06): 708-715
DOI: 10.1055/a-1985-0460
Review Article

Challenging Cases in Neurology: Neurologic Complications of COVID-19

Lucas Horta
1   Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
,
Ava Bakhtyari*
1   Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
,
Tatiana Greige*
1   Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
,
1   Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
› Author Affiliations
Funding None.

Abstract

Since the first reported cases of pneumonia in December 2019, coronavirus disease 2019 (COVID-19) has rapidly become recognized as a multisystem illness, with known effects on virtually every organ system. In particular, neurologic complications of COVID-19 have been reported since the beginning of the pandemic in both ambulatory patients with mild disease and critically ill patients. Although it remains unclear whether severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has the potential to directly invade the central nervous system, strokes and other neurovascular complications, sequelae of critical illness and metabolic derangements, parainfectious inflammatory disorders, and a poorly understood post-COVID syndrome have all been reported in patients with COVID-19. Here, we describe cases representing a diverse range of neurologic complications in patients infected with COVID-19.

* Equal contribution.




Publication History

Accepted Manuscript online:
23 November 2022

Article published online:
27 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Boehme AK, Luna J, Kulick ER, Kamel H, Elkind MSV. Influenza-like illness as a trigger for ischemic stroke. Ann Clin Transl Neurol 2018; 5 (04) 456-463
  • 2 Merkler AE, Parikh NS, Mir S. et al. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza. JAMA Neurol 2020; 77 (11) 1-7
  • 3 Wang Z, Yang Y, Liang X. et al. COVID-19 associated ischemic stroke and hemorrhagic stroke: incidence, potential pathological mechanism, and management. Front Neurol 2020; 11: 571996
  • 4 Li Y, Li M, Wang M. et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol 2020; 5 (03) 279-284
  • 5 Oxley TJ, Mocco J, Majidi S. et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med 2020; 382 (20) e60
  • 6 Beyrouti R, Adams ME, Benjamin L. et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020; 91 (08) 889-891
  • 7 Escalard S, Maïer B, Redjem H. et al. Treatment of acute ischemic stroke due to large vessel occlusion with COVID-19: experience from Paris. Stroke 2020; 51 (08) 2540-2543
  • 8 Katsanos AH, Palaiodimou L, Zand R. et al. The impact of SARS-CoV-2 on stroke epidemiology and care: a meta-analysis. Ann Neurol 2021; 89 (02) 380-388
  • 9 Wang A, Mandigo GK, Yim PD, Meyers PM, Lavine SD. Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics. J Neurointerv Surg 2020; 12 (07) 648-653
  • 10 Qureshi AI, Baskett WI, Huang W. et al. Acute ischemic stroke and COVID-19: an analysis of 27 676 patients. Stroke 2021; 52 (03) 905-912
  • 11 Perry RJ, Smith CJ, Roffe C. et al; SETICOS Collaborators. Characteristics and outcomes of COVID-19 associated stroke: a UK multicentre case-control study. J Neurol Neurosurg Psychiatry 2021; 92 (03) 242-248
  • 12 Pandey S, Holla VV, Rizvi I, Shukla R. Reversible opercular syndrome secondary to osmotic demyelination. Clin Neurol Neurosurg 2017; 155: 12-13
  • 13 Bakar M, Kirshner HS, Niaz F. The opercular-subopercular syndrome: four cases with review of the literature. Behav Neurol 1998; 11 (02) 97-103
  • 14 Ruiz-Sánchez JG, Núñez-Gil IJ, Cuesta M. et al; HOPE COVID-19 Investigators. Prognostic impact of hyponatremia and hypernatremia in COVID-19 pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) registry analysis. Front Endocrinol (Lausanne) 2020; 11: 599255
  • 15 Anand P, Zhou L, Bhadelia N, Hamer DH, Greer DM, Cervantes-Arslanian AM. Neurologic findings among inpatients with COVID-19 at a safety-net US hospital. Neurol Clin Pract 2021; 11 (02) e83-e91
  • 16 Anand P, Zakaria A, Benameur K. et al. Myoclonus in patients with coronavirus disease 2019: a multicenter case series. Crit Care Med 2020; 48 (11) 1664-1669
  • 17 Sasaguri H, Sodeyama N, Maejima Y, Kanda T, Mizusawa H. Slowly progressive Foix-Chavany-Marie syndrome associated with chronic herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 2002; 73 (02) 203-204
  • 18 Tarhan NC, Agildere AM, Benli US, Ozdemir FN, Aytekin C, Can U. Osmotic demyelination syndrome in end-stage renal disease after recent hemodialysis: MRI of the brain. AJR Am J Roentgenol 2004; 182 (03) 809-816
  • 19 Bibl D, Lampl C, Gabriel C, Jüngling G, Brock H, Köstler G. Treatment of central pontine myelinolysis with therapeutic plasmapheresis. Lancet 1999; 353 (9159): 1155
  • 20 Liotta EM, Batra A, Clark JR. et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in COVID-19 patients. Ann Clin Transl Neurol 2020; 7 (11) 2221-2230
  • 21 Helms J, Kremer S, Merdji H. et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 2020; 382 (23) 2268-2270
  • 22 Singh TD, Fugate JE, Rabinstein AA. Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol 2014; 21 (12) 1443-1450
  • 23 McKeon A, Tracy JA. GAD65 neurological autoimmunity. Muscle Nerve 2017; 56 (01) 15-27
  • 24 Gieron-Korthals MA, Westberry KR, Emmanuel PJ. Acute childhood ataxia: 10-year experience. J Child Neurol 1994; 9 (04) 381-384
  • 25 Klockgether T, Döller G, Wüllner U, Petersen D, Dichgans J. Cerebellar encephalitis in adults. J Neurol 1993; 240 (01) 17-20
  • 26 Cho TA, Schmahmann JD, Cunnane ME. Case records of the Massachusetts General Hospital. Case 30-2013. A 19-year-old man with otalgia, slurred speech, and ataxia. N Engl J Med 2013; 369 (13) 1253-1261
  • 27 Dalmau J. N2 in the time of COVID-19. Neurol Neuroimmunol Neuroinflamm 2020; 7 (05) e858
  • 28 Werner J, Reichen I, Huber M, Abela IA, Weller M, Jelcic I. Subacute cerebellar ataxia following respiratory symptoms of COVID-19: a case report. BMC Infect Dis 2021; 21 (01) 298
  • 29 Jones AL, Flanagan EP, Pittock SJ. et al. Responses to and outcomes of treatment of autoimmune cerebellar ataxia in adults. JAMA Neurol 2015; 72 (11) 1304-1312
  • 30 Haglund MM, Ojemann GA, Schwartz TW, Lettich E. Neuronal activity in human lateral temporal cortex during serial retrieval from short-term memory. J Neurosci 1994; 14 (3, Pt 2): 1507-1515
  • 31 Veroude K, Norris DG, Shumskaya E, Gullberg M, Indefrey P. Functional connectivity between brain regions involved in learning words of a new language. Brain Lang 2010; 113 (01) 21-27
  • 32 Seeßle J, Waterboer T, Hippchen T. et al. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clin Infect Dis 2022; 74 (07) 1191-1198
  • 33 Del Brutto OH, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: a longitudinal prospective study nested to a population cohort. Eur J Neurol 2021; 28 (10) 3245-3253
  • 34 Becker JH, Lin JJ, Doernberg M. et al. Assessment of cognitive function in patients after COVID-19 infection. JAMA Netw Open 2021; 4 (10) e2130645-e2130645
  • 35 Maltezou HC, Pavli A, Tsakris A. Post-COVID syndrome: an insight on its pathogenesis. Vaccines (Basel) 2021; 9 (05) 497
  • 36 Stefano GB, Ptacek R, Ptackova H, Martin A, Kream RM. Selective neuronal mitochondrial targeting in SARS-CoV-2 infection affects cognitive processes to induce ‘brain fog’ and results in behavioral changes that favor viral survival. Med Sci Monit 2021; 27: e930886