Editorial

Covid-19. Neurological manifestations

0000-0002-2980-848XJavier García Zacarías^{1  *}  , 0000-0002-2148-6594Mario Pérez Rodríguez¹  , 0000-0002-0422-2562Juan Enrique Bender del Busto² 

¹Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus, Cuba.

²Centro Internacional de Restauración Neurológica, La Habana, Cuba.

Coronaviruses were known for many years for causing frequent respiratory and digestive diseases; but of slight intensity in immunocompetent people. At the beginning of this century, in 2002 and 2012, new strains of this family originated the severe acute respiratory syndrome (SARS-CoV) and the respiratory syndrome of the Middle East (MERS-CoV) respectively, both are considered emerging diseases from an animal reservoir, and responsible for severe respiratory infections of epidemic nature with great international repercussion due to its high morbidity and mortality. ¹

In December 2019, in Wuhan, China, a group of 27 patients with pneumonia of unknown etiology was reported; soon after, Chinese researchers identified a new type of coronavirus as the causative agent, later called SARS-CoV-2. ² The disease was called covid-19 (coronavirus disease 2019). Due to its unstoppable expansion and high lethality, on March 11 the World Health Organization (WHO) declared it as a global pandemic.

SARS-CoV-2 is considered to affect the upper and lower respiratory tracts simultaneously, thus, it justifies its known transmission power and the basis for its most recognized respiratory symptoms, including pneumonia, which may or may not cause respiratory failure. ³ To this “common or typical clinical picture” are added the clinical manifestations that reflect the involvement of other organs or systems, including the nervous system, those become more valuable as knowledge of the disease deepens.

In 2016, researchers from Canada and the United Kingdom studied the case of a young patient who died as a result of encephalitis and found evidence of a direct association between the OC 43 strain of a human coronavirus (HCoV) and neurological diseases, which It demonstrates the capacity of this type of virus to invade the central nervous system. ⁴

When studying 214 hospitalized patients with a confirmed diagnosis of SARS-CoV-2, in Wuhan, China, 36.4 % had some neurological manifestation, 16.8 % of the patients presented dizziness and 14.8 % altered consciousness; they were also represented, in decreasing order, myopathies with elevated creatine kinase enzyme, headache, hypogeusia, hyposmia and neuralgia; ⁵ It has even been warned that can be presented themselves patients with atypical symptoms to covid-19 such as headache, ataxia, acute ischemic and hemorrhagic strokes, confusion symptoms and deterioration of consciousness, who have been positive to SARS-CoV-2. ⁶

In China, a 61-year-old patient, who returned from Wuhan during the pandemic, debuted with a characteristic Guillain-Barré syndrome and on the eighth day of evolution, typical clinical manifestations of covid-19 appeared and a positive test for the virus; In this case, the authors suggest a possible etiological association because this autoimmune neuropathy can be triggered by various infectious processes. ⁷

A frequent neurological finding is the loss of the sense of smell (hyposmia or anosmia), this can appear early during infection and is more frequent as part of the light pictures of covid-19, observed in children and adolescents; it has been argued that SARS-CoV-2 can enter the CNS through the cribriform plate in the ethmoid bone near the olfactory bulb and affect the brain in this way in early stages of infection. ⁸

The Radiology journal reports the first case of acute necrotizing hemorrhagic encephalopathy associated with covid-19, a rare form of encephalopathy that has already been related to other viral infections, which reaffirms the potential damage of the nervous system that this coronavirus can produce; confirmation of covid-19 infection was performed using PCR for SARS-CoV-2. ⁹

It has been shown that the most important complication and death cause in patients with covid -19 is acute respiratory failure, which recognized underlying disease is the severe pneumonia they present; ^3,10 but it is necessary to define the possible contribution of the central nervous system in the loss of involuntary control over breathing, sometimes as early. There is great similarity between SARS-CoV and SARS-CoV-2 and the neuroinvasive properties of the former have been confirmed. ¹¹

Due to the importance of the subject, the Cuban Academy of Sciences published a special article in which the most important aspects related to the neurological manifestations that appear during SARS-CoV-2 infection in covid-19 are analyzed. ¹²

The difficult task of the international scientific community to stop the expansion and mortality of covid-19 is full of questions. It is vitally important to delve into this topic in order to define the value of the damage that SARS-CoV-2 sepsis can cause to the nervous system and its repercussion on the complications and evolution of the disease; but in turn, it is essential to alert the medical community to the possibility that in patients affected by covid-19, alterations of the central and peripheral nervous system may occur.

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Received: April 01, 2020; Accepted: April 04, 2020

^*Autor para la correspondencia. Correo electrónico: [e-mail]

Los autores declaran no tener conflicto de interés en esta investigación.