Neurological Complications of COVID-19: Underlying Mechanisms and Management

Overview

Journal Int J Mol Sci

Publisher MDPI

Specialties Biochemistry
Chemistry
Molecular Biology

Date 2021 Apr 30

PMID 33920904

Citations 38

Authors

Ghaydaa A Shehata

Kevin C Lord

Michaela C Grudzinski

Mohamed Elsayed

Ramy Abdelnaby

Hatem A Elshabrawy

Affiliations

Soon will be listed here.

Abstract

COVID-19 is a severe respiratory disease caused by the newly identified human coronavirus (HCoV) Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The virus was discovered in December 2019, and in March 2020, the disease was declared a global pandemic by the World Health Organization (WHO) due to a high number of cases. Although SARS-CoV-2 primarily affects the respiratory system, several studies have reported neurological complications in COVID-19 patients. Headache, dizziness, loss of taste and smell, encephalitis, encephalopathy, and cerebrovascular diseases are the most common neurological complications that are associated with COVID-19. In addition, seizures, neuromuscular junctions' disorders, and Guillain-Barré syndrome were reported as complications of COVID-19, as well as neurodegenerative and demyelinating disorders. However, the management of these conditions remains a challenge. In this review, we discuss the prevalence, pathogenesis, and mechanisms of these neurological sequelae that are secondary to SARS-CoV-2 infection. We aim to update neurologists and healthcare workers on the possible neurological complications associated with COVID-19 and the management of these disease conditions.

Citing Articles

Guillain-Barré syndrome (GBS) after severe/critical COVID-19 or COVID-19 vaccination.

Bahrami S, Ansari B, Norouzi-Barough L, Bagherpour B, Khorvash F, Shirani K Eur J Med Res. 2025; 30(1):131.

PMID: 39994747 PMC: 11849160. DOI: 10.1186/s40001-025-02378-w.

Facial Nerve Palsy Amid the SARS-CoV-2 Pandemic: A Pooled Analysis.

Mirza A, Almalki A, Noori F, Neazy S, Dahm V, Bajin M J Otolaryngol Head Neck Surg. 2025; 54:19160216251315057.

PMID: 39916377 PMC: 11803641. DOI: 10.1177/19160216251315057.

Impact of underlying diseases and complications on COVID-19 mortality in South Korea: analysis of national health insurance service data.

Lee K, Hwang J Arch Public Health. 2025; 83(1):20.

PMID: 39849609 PMC: 11755852. DOI: 10.1186/s13690-025-01509-3.

Neuropsychiatric Burden of SARS-CoV-2: A Review of Its Physiopathology, Underlying Mechanisms, and Management Strategies.

Pacnejer A, Butuca A, Dobrea C, Arseniu A, Frum A, Gligor F Viruses. 2025; 16(12.

PMID: 39772122 PMC: 11680421. DOI: 10.3390/v16121811.

mC RNA methylation: a potential mechanism for infectious Alzheimer's disease.

Teng S, Han C, Zhou J, He Z, Qian W Front Cell Dev Biol. 2024; 12:1440143.

PMID: 39175875 PMC: 11338875. DOI: 10.3389/fcell.2024.1440143.

References

Sulzer D, Antonini A, Leta V, Nordvig A, Smeyne R, Goldman J . COVID-19 and possible links with Parkinson's disease and parkinsonism: from bench to bedside. NPJ Parkinsons Dis. 2020; 6:18. PMC: 7441399. DOI: 10.1038/s41531-020-00123-0. View

Sharifian-Dorche M, Sahraian M, Fadda G, Osherov M, Sharifian-Dorche A, Karaminia M . COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review. Mult Scler Relat Disord. 2021; 50:102800. PMC: 7845520. DOI: 10.1016/j.msard.2021.102800. View

Zhou P, Yang X, Wang X, Hu B, Zhang L, Zhang W . A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579(7798):270-273. PMC: 7095418. DOI: 10.1038/s41586-020-2012-7. View

Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L . Self-reported Olfactory and Taste Disorders in Patients With Severe Acute Respiratory Coronavirus 2 Infection: A Cross-sectional Study. Clin Infect Dis. 2020; 71(15):889-890. PMC: 7184514. DOI: 10.1093/cid/ciaa330. View

Ford T, Curiale G, Nguyen T, Aparicio H, Hamlyn E, Gangadhara S . Optimization of resources and modifications in acute ischemic stroke care in response to the global COVID-19 pandemic. J Stroke Cerebrovasc Dis. 2020; 29(8):104980. PMC: 7245329. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104980. View

Lau K, Yu W, Chu C, Lau S, Sheng B, Yuen K . Possible central nervous system infection by SARS coronavirus. Emerg Infect Dis. 2004; 10(2):342-4. PMC: 3322928. DOI: 10.3201/eid1002.030638. View

Bernard-Valnet R, Pizzarotti B, Anichini A, Demars Y, Russo E, Schmidhauser M . Two patients with acute meningoencephalitis concomitant with SARS-CoV-2 infection. Eur J Neurol. 2020; 27(9):e43-e44. PMC: 7267660. DOI: 10.1111/ene.14298. View

Radmanesh A, Derman A, Ishida K . COVID-19-associated delayed posthypoxic necrotizing leukoencephalopathy. J Neurol Sci. 2020; 415:116945. PMC: 7251359. DOI: 10.1016/j.jns.2020.116945. View

Ross Reichard R, Kashani K, Boire N, Constantopoulos E, Guo Y, Lucchinetti C . Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol. 2020; 140(1):1-6. PMC: 7245994. DOI: 10.1007/s00401-020-02166-2. View

10.

Algahtani H, Subahi A, Shirah B . Neurological Complications of Middle East Respiratory Syndrome Coronavirus: A Report of Two Cases and Review of the Literature. Case Rep Neurol Med. 2016; 2016:3502683. PMC: 4864560. DOI: 10.1155/2016/3502683. View

11.

Tatu L, Nono S, Gracio S, Kocer S . Guillain-Barré syndrome in the COVID-19 era: another occasional cluster?. J Neurol. 2020; 268(4):1198-1200. PMC: 7309426. DOI: 10.1007/s00415-020-10005-3. View

12.

Cabeca T, Granato C, Bellei N . Epidemiological and clinical features of human coronavirus infections among different subsets of patients. Influenza Other Respir Viruses. 2013; 7(6):1040-7. PMC: 4634278. DOI: 10.1111/irv.12101. View

13.

Salahuddin H, Castonguay A, Zaidi S, Burgess R, Jadhav A, Jumaa M . Interventional Stroke Care in the Era of COVID-19. Front Neurol. 2020; 11:468. PMC: 7225772. DOI: 10.3389/fneur.2020.00468. View

14.

Puccioni-Sohler M, Poton A, Franklin M, Da Silva S, Brindeiro R, Tanuri A . Current evidence of neurological features, diagnosis, and neuropathogenesis associated with COVID-19. Rev Soc Bras Med Trop. 2020; 53:e20200477. PMC: 7534972. DOI: 10.1590/0037-8682-0477-2020. View

15.

Nicholls J, Butany J, Poon L, Chan K, Beh S, Poutanen S . Time course and cellular localization of SARS-CoV nucleoprotein and RNA in lungs from fatal cases of SARS. PLoS Med. 2005; 3(2):e27. PMC: 1324951. DOI: 10.1371/journal.pmed.0030027. View

16.

Li Y, Bai W, Hashikawa T . The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020; 92(6):552-555. PMC: 7228394. DOI: 10.1002/jmv.25728. View

17.

Oda Plasencia-Garcia B, Rodriguez-Menendez G, Rico-Rangel M, Rubio-Garcia A, Torello-Iserte J, Crespo-Facorro B . Drug-drug interactions between COVID-19 treatments and antipsychotics drugs: integrated evidence from 4 databases and a systematic review. Psychopharmacology (Berl). 2021; 238(2):329-340. PMC: 7788177. DOI: 10.1007/s00213-020-05716-4. View

18.

Akima S, McLintock C, Hunt B . RE: ISTH interim guidance to recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020; 18(8):2057-2058. PMC: 9770917. DOI: 10.1111/jth.14853. View

19.

Abassi Z, Knaney Y, Karram T, Heyman S . The Lung Macrophage in SARS-CoV-2 Infection: A Friend or a Foe?. Front Immunol. 2020; 11:1312. PMC: 7291598. DOI: 10.3389/fimmu.2020.01312. View

20.

Sormani M . An Italian programme for COVID-19 infection in multiple sclerosis. Lancet Neurol. 2020; 19(6):481-482. PMC: 7191287. DOI: 10.1016/S1474-4422(20)30147-2. View