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Features and Management of Acute and Chronic Neuro-Covid

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This book delineates that COVID-19 is a multisystem inflammatory disease and how its pathophysiology can predispose patients to an increased risk of neurological problems. Available data suggest the potential neuroinvasive capacity of the SARS-CoV-2 through direct viral damage and indirect entering the CNS by different routes including the vascular system, the olfactory and trigeminal nerves, the cerebrospinal fluid, and the lymphatic system. Furthermore, the pro-inflammatory cytokine storm and oxidative stress can induce microglial activation and damaging the blood-brain barrier, culminating in widespread neuroinflammatory processes. This acute neurotoxicity is clinically expressed as anosmia, ageusia, headache, nausea and vomiting. Other neurologic manifestations such as acute cerebrovascular diseases, encephalitis-based impaired consciousness, and meningitis are also described.

The PNS can also be affected and clinical manifestations including Guillain-Barré syndrome, polyneuritis, Miller Fisher Syndrome, and other problems are described. A special issue concerns the neurocognitive dysfunction and altered consciousness manifested as delirium, agitation, and confusion. Non-specific symptoms such as dizziness, and seizures can accompany clinical pictures.

Regardless of the admitting diagnosis, a high percentage of patients discharged from ICUs develop disabilities affecting physical, cognitive and psychological activities. The symptoms such as asthenia, memory disturbances, depression, sleep disturbances, anxiety, and Post-traumatic Stress Disorder (PTSD), can configure the so-called Post-intensive Care Syndrome (PICS). Multimodal management during the ICU stay and implementation of follow-up programs on patient discharge can reduce the incidence of this syndrome, improving the quality of life of surviving individuals.

In this complex scenario, a careful clinical approach through reliable diagnostic tools, and epidemiological studies aimed at evaluating the dimensions of the problem also in economic terms, is urgently needed.

This book represents a valuable aid for all healthcare professionals (intensivists, neurologist and psychiatrists, as well as others) involved in the management of these critically ill patients.

Author(s): Marco Cascella, Elvio De Blasio
Publisher: Springer
Year: 2021

Language: English
Pages: 177
City: Cham

Foreword
Preface
Acknowledgments
Contents
Abbreviations
1: Pathophysiology of COVID-19-Associated Neurotoxicity
1.1 Introduction
1.2 Overview on Neurological Manifestations
1.3 Pathophysiology of COVID-19-Associated Neurotoxicity
1.3.1 The Issue of SARS-CoV-2 Neurotropism
1.3.1.1 The Evidence for SARS-CoV-2 in Nerve Tissue
1.3.1.2 Pathogenesis of Direct SARS-CoV-2 Damage
1.3.1.3 The Ligand–Receptor Interaction and “Postreceptorial Mechanisms” in Nervous Tissue
1.3.2 Mechanisms of Diffusion Towards the Nervous Tissue
1.3.2.1 The Hematogenous Route
1.3.2.2 The Neurogenic Pathway
1.3.2.3 Other Possible Routes
1.3.3 Immune-Mediated Neurological Processes
1.3.3.1 Cytokine Storm
1.3.3.2 Microglial Activation and Blood–Brain Barrier Damage
1.3.4 Gut–Brain Axis Involvement
1.3.5 Effects of Multiorgan Dysfunction
1.4 Potential Mechanisms for Long-Term Neurotoxicity
1.5 Pain and COVID-19: The COVID-Pain Issue
1.5.1 Acute Clinical Manifestations
1.5.2 Long-Term Painful Clinical Manifestations
1.6 Ongoing Clinical Research
1.7 Research Perspectives
1.8 Conclusions
References
2: Acute Manifestations of Neuro-COVID
2.1 Introduction. Overview on Clinical Manifestations of the Disease
2.2 Pathogenic Mechanisms
2.3 Classification Approaches
2.4 Central Nervous System Manifestations
2.4.1 Headache and Dizziness
2.4.2 Acute Encephalopathy
2.4.3 Posterior Reversible Encephalopathy Syndrome
2.4.4 Seizures
2.4.5 Acute Cerebrovascular Diseases
2.4.6 Meningitis and Encephalitis
2.4.7 Acute Myelitis
2.5 PNS Manifestations
2.5.1 Hypo/Anosmia and Dysgeusia/Ageusia
2.5.2 Guillain-Barré Syndrome and Variants
2.5.3 Pain
2.6 Skeletal Muscle Manifestations
2.6.1 Asthenia and Myalgia
2.6.2 Skeletal Muscle Injury
2.7 Psychiatric Manifestations
2.8 Conclusions
References
3: Diagnostic Approaches to Acute Neuro-COVID
3.1 Introduction
3.2 Neuroimaging
3.2.1 Stroke
3.2.2 Cerebral Hemorrhagic Lesions
3.2.3 Mixed Pictures
3.2.4 Posterior Reversible Encephalopathy Syndrome
3.2.5 Encephalitis
3.2.6 Myelitis
3.2.7 Peripheral Nervous System and Muscular Disorders
3.2.8 Clinical and Neuroimaging Correlation
3.2.9 The Role of Brain Positron Emission Tomography
3.2.10 Other Diagnostic Approaches
3.3 Electrodiagnostic Tests
3.3.1 EEG: Indications, Approaches, Features, and Limitations
3.3.2 ICU-Acquired Weakness in COVID-19 Patients
3.3.3 Mixed CNS/PNS Pictures
3.4 Laboratory Tests
3.5 Neuropathological Findings
3.6 Conclusions
References
4: Neurological, Psychological, and Cognitive Manifestations of Long-COVID
4.1 Introduction
4.2 The Long-COVID Phenomenon in Numbers
4.3 Neurological Symptoms
4.3.1 Mechanisms
4.3.2 Clinical Features
4.4 Psychological Sequelae of Long-COVID
4.4.1 Disease-Related or Pandemic-Induced Effects?
4.4.2 From Acute to Chronic Psychiatric Problems
4.5 Potential Long-Term Cognitive Issues
4.6 Conclusions
References