Potential Neurological Symptoms Of COVID-19

Original Article: Wang, H.-Y., Li, X.-L., Yan, Z.-R., Sun, X.-P., Han, J., & Zhang, B.-W., Potential neurological symptoms of COVID-19, Therapeutic Advances in Neurological Disorders

Author of summary: Francesca Di Vozzo; Reviewer: Lanfranco Pellesi

Original Article Published on March 28th, 2020

The authors of this letter discuss the possible neurological symptoms in patients diagnosed with COVID-19 and propose a hypothesis that explains the physiological relationship between the incidence of cerebral hemorrhage and COVID-19.

This letter to the editor discusses the neurological symptoms in COVID-19 positive patients. The authors highlight that some patients diagnosed with COVID-19 have not shown typical respiratory symptoms, such as fever and coughing. Some exhibited only neurological symptoms as the initial symptoms, such as:

  • Headache, languidness, unstable walking, and malaise, which could be due to nonspecific manifestations caused by COVID-19
  • Cerebral hemorrhage
  • Cerebral infarction
  • Other neurological diseases

In a recent study of 214 patients with COVID-19, 78 (36.4%) showed neurological manifestations such as headache, dizziness, acute cerebrovascular diseases, and impaired consciousness. Of these 214 patients, 40 (18.7%) required intensive care unit for serious neurological problems.

Currently, even though there have been many cases of patients with COVID-19 whose conditions have been complicated by cerebral hemorrhages, relevant studies focusing on this aspect are lacking. Hence, the physiological relationship between COVID-19 and the incidence of cerebral hemorrhage remains unclear. Several lines of evidence suggest a hypothetical relationship. Angiotensin-converting enzyme 2 (ACE2) receptors present on the surface of human respiratory epithelial cells are necessary for SARS-CoV-2 to infect cells. ACE2 signaling lowers blood pressure. Following SARS-CoV-2 infection, the expression and function of ACE2 proteins are reduced. Since the expression of ACE2 in patients with hypertension is already low, SARS-CoV-2 infection is more likely to induce cerebral hemorrhage in such patients. Also, patients with COVID-19 suffer often from coagulopathies, increase in D-dimers and prolonged prothrombin time, all contributing factors to possible secondary cerebral hemorrhages. In contrast, no cases of secondary cerebral infarctions have been reported in patients with COVID-19.

The authors speculate also that COVID-19 has the potential to induce cerebral venous and/or arterial infarctions. Finally, few studies have reported any cases of neurological damage associated with COVID-19. A recent report shows that SARS-CoV-2 can attack and damage the nervous system, with the detection of SARS-CoV-2 RNA in the cerebrospinal fluid.

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