COVID-19 Neurological Effects

Neurologic effects can be a significant part of COVID-19, but does the SARS-CoV-2 virus directly damage the central nervous system or are the neurologic symptoms attributable to secondary mechanisms?

A new review article summarizes what is known so far, and what clinicians need to look out for.

The review was published online May 29 in JAMA Neurology.

Loss of smell and/or taste is a common symptom in COVID-19, so this may suggest that an awful lot of people have some neurological involvement. While a transient loss of smell or taste is not serious, if the virus has infected brain tissue the question is could this then spread to other parts of the brain and cause other more serious neurological effects.

In their review article, Spudich and colleagues present evidence showing that coronaviruses can enter the CNS.

The majority of neurologic symptoms in COVID-19 patients are most probably complications of other systemic effects, such as kidney, heart, or liver problems. But there is likely also a direct viral effect on the CNS in some patients.

On the increase in strokes that has been reported in COVID-19 patients could be due to direct effects of the virus (eg, causing an increase in coagulation or infecting the endothelial cells in the brain) or it could just be the final trigger for patients who were at risk of stroke anyway.