Skip to main content
NCBI home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2022 Jan 3;51(9):1222–1227. doi: 10.1007/s11055-021-01183-2

Central Nervous System Lesions in COVID-19

O V Kurushina 1,✉, A E Barulin 1
PMCID: PMC8720549  PMID: 35001988

Abstract

This review discusses current data on CNS lesions in infections with the new coronavirus that causes COVID-19. The pathogenetic mechanisms leading to infection of the brain and spinal cord are presented. Published studies and meta-analyses published by autumn 2020 are assessed. The authors present results from their own clinical observations of various types of CNS infection in COVID-19 virus disease. Particular attention is paid to certain common forms of CNS lesion such as encephalitis, cerebrovascular pathology, and headache. A form of acute hemorrhagic necrotic encephalopathy is identified, which is a quite rare but fatal pathology comorbid with COVID-19. A description of our own clinical observation of acute necrotic encephalopathy is presented. The importance of further studies of the effects of the coronavirus on the CNS and possible approaches to treatment and rehabilitation of this category of patients is emphasized.

Keywords: COVID-19, acute hemorrhagic necrotic encephalopathy, central nervous system

Footnotes

Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 121, No. 1, Iss. 1, pp. 92–97, January, 2021.

References

  • 1.Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol. Sci. 2020;41(7):1667–1671. doi: 10.1007/s10072-020-04486-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: a literature review. J. Clin. Neurosci. 2020;77:8–12. doi: 10.1016/j.jocn.2020.05.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.World Health Organization, Coronavirus Disease (COVID-19) Situation Report – 160, Data as Received by WHO from National Authorities by 10:00 CEST, June 28, 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200628-covid-19-sitrep-160.pdf?sfvrsn=2fe1c658_2, acc. Aug. 27, 2020.
  • 4.Bridwell R, Long B, Gottlieb M. Neurologic complications of COVID-19. Am. J. Emerg. Med. 2020;38(7):1549.e3–1549.e7. doi: 10.1016/j.ajem.2020.05.024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Fan H, Tang X, Song Y, et al. Influence of COVID-19 on cerebrovascular disease and its possible mechanism. Neuropsychiatr. Dis. Treat. 2020;16:1359–1367. doi: 10.2147/NDT.S251173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Tsivgoulis G, Palaiodimou L, Katsanos AH, et al. Neurological manifestations and implications of COVID-19 pandemic. Ther. Adv. Neurol. Disord. 2020;13:1756286420932036. doi: 10.1177/1756286420932036. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Wang J, Hajizadeh N, Moore EE, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS), a case series. J. Thromb. Haemost. 2020;18(7):1752–1755. doi: 10.1111/jth.14828. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J. Thromb. Haemost. 2020;18(5):1094–1099. doi: 10.1111/jth.14817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Li YC, Bai WZ, 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. doi: 10.1002/jmv.25728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Cheng H, Wang Y, Wang GQ. Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19. J. Med. Virol. 2020;92(7):726–730. doi: 10.1002/jmv.2578. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Steardo L, Steardo L, Jr, Zorec R, Verkhratsky A. Neuroinfection may contribute to pathophysiology and clinical manifestations of COVID-19. Acta Physiol. 2020;229(3):e13473. doi: 10.1111/apha.13473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Yashavantha Rao HC, Jayabaskaran C. The emergence of a novel coronavirus (SARS-CoV-2) disease and their neuroinvasive propensity may affect in COVID-19 patients. J. Med. Virol. 2020;92(7):786–790. doi: 10.1002/jmv.25918. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Sheraton M, Deo N, Kashyap R, Surani S. A review of neurological complications of COVID-19. Cureus. 2020;12(5):e8192. doi: 10.7759/cureus.8192. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Tu H, Tu S, Gao S, et al. The epidemiological and clinical features of COVID-19 and lessons from this global infectious public health event. J. Infect. 2020;81(1):1–9. doi: 10.1016/j.jinf.2020.04.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Tveito K. Cytokine storms in COVID-19 cases. Tidsskr. Nor. Laegeforen. 2020;23:140. doi: 10.4045/tidsskr.20.0239. [DOI] [PubMed] [Google Scholar]
  • 17.Filatov A, Sharma P, Hindi F. Neurological complications of coronavirus disease COVID-19, encephalopathy. Cureus. 2020;12(3):e7352. doi: 10.7759/cureus.7352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med. Infect. Dis. 2020;34:101623. doi: 10.1016/j.tmaid.2020.101623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):1–9. doi: 10.1001/jamaneurol.2020.1127. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Scullen T, Keen J, Mathkour M, et al. Coronavirus 2019 (COVID-19)-Associated encephalopathies and cerebrovascular disease: The New Orleans experience. World Neurosurg. 2020;141:e437–e446. doi: 10.1016/j.wneu.2020.05.192. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Correia AO, Feitosa PWG, Moreira JLDS, et al. Neurological manifestations of COVID-19 and other coronaviruses: a systematic review. Neurol. Psychiatry Brain Res. 2020;37:27–32. doi: 10.1016/j.npbr.2020.05.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Azhideh A. COVID-19 neurological manifestations. Int. Clin. Neurosci. J. 2020;7(2):54. doi: 10.34172/icnj.2020.01. [DOI] [Google Scholar]
  • 23.Reddy ST, Garg T, Shah C, et al. Cerebrovascular disease in patients with COVID-19: a review of the literature and case series. Case Rep. Neurol. 2020;12(2):199–209. doi: 10.1159/000508958. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav. Immun. 2020;87:18–22. doi: 10.1016/j.bbi.2020.03.031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Poyiadji N, Shahin G, Noujaim D, et al. COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 2020;296(2):119–120. doi: 10.1148/radiol.2020201187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.P. Xiang, X. M. Xu, L. L. Gao, et al., “First case of 2019 novel coronavirus disease with encephalitis,” ChinaXiv, T202003.00015 (2020).
  • 27.Moriguchi T, Harii N, Goto J, et al. A fi rst case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int. J. Infect. Dis. 2020;94:55–58. doi: 10.1016/j.ijid.2020.03.062. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Brüggemann R, Gietema H, Jallah B, et al. Arterial and venous thromboembolic disease in a patient with COVID-19: a case report. Thromb. Res. 2020;191:153–155. doi: 10.1016/j.thromres.2020.04.046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. doi: 10.1136/bmj.m1091. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Bridwell R, Long B, Gottlieb M. Neurologic complications of COVID-19. Am. J. Emerg. Med. 2020;38(7):1549.e3–1549.e7. doi: 10.1016/j.ajem.2020.05.024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (COVID-19): encephalopathy. Cureus. 2020;12(3):e7352. doi: 10.7759/cureus.7352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Benger M, Williams O, Siddiqui J, Sztriha L. Intracerebral haemorrhage and COVID-19: clinical characteristics from a case series. Brain Behav. Immun. 2020;88:940–944. doi: 10.1016/j.bbi.2020.06.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral haemorrhage: causative or coincidental. New Microbes New Infect. 2020;35:100669. doi: 10.1016/j.nmni.2020.100669. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Sotoca J, Rodríguez-Álvarez Y. COVID-19-associated acute necrotizing myelitis. Neurol. Neuroimmunol. Neuroinfl amm. 2020;7(5):e803. doi: 10.1212/NXI.0000000000000803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.AlKetbi R, AlNuaimi D, AlMulla M, et al. Acute myelitis as a neurological complication of Covid-19: a case report and MRI findings. Radiol. Case Rep. 2020;15(9):1591–1595. doi: 10.1016/j.radcr.2020.06.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Munz M, Wessendorf S, Koretsis G, et al. Acute transverse myelitis after COVID-19 pneumonia. J. Neurol. 2020;267(8):2196–2197. doi: 10.1007/s00415-020-09934-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Poyiadji N, Cormier P, Patel PY, et al. Acute pulmonary embolism and COVID-19. Radiology. 2020;297(3):335–338. doi: 10.1148/radiol.2020201955. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J. Thromb. Haemost. 2020;18(5):1094–1099. doi: 10.1111/jth.14817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Desforges M, Le Coupanec A, Dubeau P, et al. Human coronaviruses and other respiratory Viruses: underestimated opportunistic pathogens of the central nervous system. Viruses. 2019;12(1):14. doi: 10.3390/v12010014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Liu F, Li L, Xu M, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J. Clin. Virol. 2020;127:104370. doi: 10.1016/j.jcv.2020.104370. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Neuroscience and Behavioral Physiology are provided here courtesy of Nature Publishing Group

RESOURCES