Review Article
Emerging potential mechanisms and predispositions to the neurological manifestations of COVID-19

https://doi.org/10.1016/j.jns.2021.117608Get rights and content

Highlights

  • The pathophysiology of NeuroCOVID is complex, likely entailing a combination of separate and overlapping mechanisms.

  • There is increasing evidence for genetic predispositions to NeuroCOVID.

  • The long-term symptoms of COVID-19 also represent an impending burden on healthcare services.

  • Future studies should subsequently aim to further explore demographic and genetic risk factors for developing long COVID.

  • In particular, the chronic neurological symptoms of COVID-19 are poorly understood, warranting further research.

Abstract

A spectrum of neurological disease associated with COVID-19 is becoming increasingly apparent. However, the mechanisms behind these manifestations remain poorly understood, significantly hindering their management. The present review subsequently attempts to address the evolving molecular, cellular and systemic mechanisms of NeuroCOVID, which we have classified as the acute and long-term neurological effects of COVID-19. We place particular emphasis on cerebrovascular, demyelinating and encephalitic presentations, which have been reported. Several mechanisms are presented, especially the involvement of a “cytokine storm”. We explore the genetic and demographic factors that may predispose individuals to NeuroCOVID. The increasingly evident long-term neurological effects are also presented, including the impact of the virus on cognition, autonomic function and mental wellbeing, which represent an impending burden on already stretched healthcare services. We subsequently reinforce the need for cautious surveillance, especially for those with predisposing factors, with effective clinical phenotyping, appropriate investigation and, if possible, prompt treatment. This will be imperative to prevent downstream neurological sequelae, including those related to the long COVID phenotypes that are being increasingly recognised.

Keywords

COVID-19
SARS-CoV-2
Neurology
NeuroCOVID

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