COVID-19 and the brain

Abstract

Entering the third year into the pandemic, overwhelming evidence demonstrates that Coronavirus disease 2019 (COVID-19) infection is a systemic illness, often with involvement of the central nervous system. Multiple mechanisms may underlie the development of neurologic manifestations of illness, including hypoxia, systemic illness, hypercoagulability, endothelial dysfunction, general critical illness, inflammatory response, and neurotropism of the severe acute respiratory syndrome coronavirus 2 (SARS-Co-V2) virus. COVID-19 infection is associated with neurologic involvement in all stages; acute infection, subacute/post-infection, and growing evidence also suggests during a chronic phase, the post-acute sequalae of COVID-19 (PASC). With over 20,000 published articles on COVID and the brain at the time of writing, it is virtually impossible to present an unbiased comprehensive review of how SARS-Co-V2 impacts the nervous system. In this review, we will present an overview of common neurologic manifestations, in particular focusing on the cerebrovascular complications, and proposed pathophysiology.

Keywords: CNS Vasculitis; COVID-19; Neurologic complications; SARS-CoV-2; Stroke.

Copyright © 2022. Published by Elsevier Inc.

Figures

Fig. 1.

This schematic demonstrates the spectrum of neurologic complications which have been associated with SARS-CoV-2 infections. The pathologic manifestations are wide ranging from vascular manifestations (hemorrhagic and ischemic strokes, PRES, CVST), generalized CNS disorders (seizures, meningitis, encephalitis), to peripheral neuropathies (GBS, cranial neuropathies) and post-infectious sequelae (long COVID). The proposed mechanisms behind these injuries include immune dysregulation, aberrant thrombogenesis and multi-organ failure in the setting of critical illness. Please refer to table 1 for a more comprehensive list.