The main manifestations of COVID-19 are respiratory and cardiac. However, the literature describes cases when patients had neurological symptoms that often precede and anticipate typical disease manifestations.

What are the neurological symptoms of COVID-19? Neurological disorders seen in patients with COVID-19 can precede the onset of general symptoms of the disease and, at times, can be fatal in and of themselves.

A typical post-covid-19 neurological symptom includes fever, dry cough, and asthenia. However, in some patients at the time of diagnosis, neurological syndrome and neurological disorders (headache, even severe headaches, general malaise, and difficulty walking) are mainly observed.

It is estimated that during COVID-19 infection, more than 35% of patients develop neurological syndrome, the severity of which correlates with the severity of the infection.

The most common neurological symptoms reported in patients are:

  • dizziness
  • feeling numb
  • hypogeusia
  • ageusia
  • hyposmia
  • anosmia
  • myalgia.

Some of these, such as anosmia and ageusia, are very common post-covid-19 neurological manifestations, especially in asymptomatic patients, and may even precede respiratory symptoms.

Thus, early recognition of the involvement of the virus in the nervous system is beneficial for suspecting the presence of COVID-19 already in the early stages of the disease.

Neurological pathologies that can occur in patients with COVID-19 are mainly:

  • stroke (ischemic or hemorrhagic, secondary to coagulopathy)
  • venous thrombosis
  • cerebral hemorrhage
  • encephalopathy
  • changes in consciousness
  • meningitis
  • encephalitis
  • febrile seizures
  • encephalomyelitis
  • myelitis
  • myasthenia gravis
  • Guillain-Barré syndrome and Miller-Fisher syndrome.

Such manifestations are usually associated with more severe forms of the infectious disease COVID-19.

Neurological complications can be contagious. They may be related to the effects that COVID-19 has on the immune system.

The virus’s ability to damage neurons and cause inflammation can contribute to or increase the risk of contracting even serious neurological diseases.

Recent research suggests that SARS-CoV-2 infection, which has been seen in the past for other viral infections, may be associated with an increased risk of neurodegenerative diseases and faster cognitive decline in older adults with underlying medical conditions.

It should be borne in mind that in hospitalized patients, neurological symptoms, in addition to being caused by a viral infection, may also result from the use of certain combinations of antiviral therapy for long periods.

How does COVID-19 enter the nervous system?

How does COVID-19 enter the nervous system

Could COVID-19 Infection Cause Psychiatric Symptoms? In addition to the neurological syndrome, patients with COVID-19 can also cause developmental disorders. The latter can occur at different stages of the disease. During an acute state of infection, the following are observed:

  • insomnia (41.9%)
  • anxiety (35.7%)
  • memory impairment (34.1%)
  • depression (32.6%)
  • state of confusion (27.9%).

On the other hand, during the period of remission, sleep disorders were found, especially insomnia (100%), the presence of traumatic memories (30.4%), memory impairment (18.9%), irritability (12.8%), anxiety (12, 3%), and depression (10.5%). 

The neurological symptoms associated with COVID-19 may result from direct viral invasion associated with the virus’s propensity to attack neuronal cells.

The brain is an organ that has great potential for viral replication. The virus could directly enter the brain through the nasal mucosa. However, on the path of penetration through the blood, endothelial cells will participate, followed by astrocytes.

Another possibility may be related to the ability of the virus to reach the central nervous system from the gastrointestinal tract through the intestinal nervous system. The increased permeability of the blood-brain barrier resulting from systemic inflammation and the release of cytokines will also facilitate the penetration of the virus into the brain. Once in the nervous system, the coronavirus can enter the brain stem and contribute, if not exacerbate, changes in respiratory and cardiac function that usually occur in the early stages of COVID-19 infection.

There may also be indirect effects mediated by the host cells’ cytotoxic response in neuropsychiatric manifestations or by a strong inflammatory response. The release of molecules promotes clots that clog blood vessels, causing phenomena such as strokes and thromboembolism.

Treatment of neurological syndrome associated with COVID-19 infection

Treatment of neurological syndrome associated

The treatment of neurological disorders during COVID-19 does not currently include specific therapy. Controlling these aspects is associated with the therapy used for the infection (e.g., antiviral drugs or monoclonal antibodies).

Several medications have been suggested to control specific symptoms. These include the topical use of corticosteroids in the nose to control anosmia or vitamin D as a neuroprotective agent. However, their use is still controversial, and further research is needed.

However, the use of anticoagulants appears to be associated with an improved prognosis, especially in patients with serious illness and concomitant diseases, since they can significantly reduce the formation of blood clots in the blood vessels of the brain. Rehabilitation of neurological consequences after COVID-19

Among the main complaints are muscle pain, headaches, dizziness, memory impairment, depression, confusion, impaired taste, and smell. Several months after recovery, some patients show cognitive impairment, mental impairment, and post-covid-19 neurological impairment. These side effects are because mild to moderate forms of the new coronavirus infection can cause long-term effects on the central nervous system.

Almost all patients need a rehabilitation course after COVID-19, regardless of the severity of the infection. Rehabilitation in the early stages can significantly reduce the risk of negative consequences and neurological syndrome after suffering COVID-19 and return to the previous quality of life and improve emotional state, mood, and performance. 80% of patients noted positive dynamics after the third for rehabilitation.

The coronavirus rehabilitation program is recommended for patients who have undergone COVID-19 and have neurological consequences:

  • Anosmia. Augesia
  • Asthenia weakness decreased exercise tolerance
  • Thermoregulatory disorders (chills)
  • Deterioration and loss of memory, fog in the head. PIT syndrome
  • Sensorineural hearing loss, vestibulopathy (dizziness)
  • Lesions of the oculomotor nerves
  • Sensory polyneuropathy.

The coronavirus rehabilitation program is indicated for patients with the following symptoms:

  • Weakening, perversion, or lack of taste (hypogeusia).
  • Loss of gustatory sensitivity (ageusia).
  • Perversion of gustatory sensitivity, the appearance of new gustatory sensations.
  • Loss of smell (anosmia).
  • Pathological fatigue (asthenia).
  • Thermoregulation disorders (chills).
  • Decreased exercise tolerance (fatigue).
  • Memory impairment, fog in the head, PIT syndrome.
  • Sensorineural hearing loss, vestibulopathy.
  • Damage to the oculomotor nerves.
  • Sensory polyneuropathy, polyneuropathy.