Neurological Manifestations of Covid-19: An Overview

1. A D E W I J A Y A M D – A P R I L 2 0 2 0
Neurological Manifestations of
COVID-19

2. World Pandemic by WHO on 11 March 2020

3. International Journal of Biological Sciences 16: 1753
Hoffmann, M., Kleine-Weber, H., Schroeder, S., Krüger, N., Herrler, T., Erichsen, S., ... & Müller, M. A. (2020). SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2
and is blocked by a clinically proven protease inhibitor. Cell.

4. Tissue distribution of ACE2 receptors in humans. Viremia (A) disseminates the COVID-19 virus throughout the body via the
bloodstream (B). Neurotropism may occur via circulation and/or an upper nasal trancribrial route that enables the COVID-
19 to reach the brain (C) and bind and engage with the ACE2 receptors (D, blue). COVID-19 docks on the ACE2 via spike
protein (D, golden spikes). Shown are lungs, heart, kidneys, intestines, brain, and testicles that are well-known to express
ACE2 receptors and are possible targets of COVID-19.
Palasca O.; Santos A.; Stolte C.; Gorodkin J.; Jensen L. J. (2018) TISSUES 2.0: an integrative web resource on mammalian tissue expression. Database 2018,
bay00310.1093/database/bay003

5. Neurological Symptoms and Signs
 Dizziness
 Headache
 Impaired consciousness
 Focal neurological deficits
 Ataxia
 Seizure
 Taste, smell, and vision impairments
 Neuralgia
Consensus for prevention and management of coronavirus disease 2019 for neurologists

6. Neurological Manifestations
Acute Cerebrovascular Diseases
Intracranial Infection
Muscle Damage
Consensus for prevention and management of coronavirus disease 2019 for neurologists

7. COVID-19 and Acute Cerebrovascular Diseases
 Increase serum D-dimer level  embolic vascular
events
 Thrombocytopenia  cerebral hemorrhage
Treatment:
- Anticoagulation in embolic events
- Avoid ACEi / ARB as antihypertension
Consensus for prevention and management of coronavirus disease 2019 for neurologists

8. COVID-19 and Intracranial Infection
 Coronavirus may invade the central nervous system;
coronavirus nucleic acid detected in cerebrospinal
fluid
 Diagnosis: MRI and spinal tap
 Treatment:
- Controlling cerebral edema
- Treating and preventing seizures
- Terating psychotic symptoms
Consensus for prevention and management of coronavirus disease 2019 for neurologists

9. COVID-19 and Muscle Damage
 Skeletal muscle damage:
- Fatique
- Limb aches
- Mild elevation of serum creatine kinase level
Pathophysiology:
Inflammation & direct muscle damage by the virus
Consensus for prevention and management of coronavirus disease 2019 for neurologists

10. Summary
 COVID-19 is a highly contagious worldwide
pandemic disease
 Patients infected may show neurological symptoms
first
 High index of suspicion in endemic area to prevent
clinical worsening and spreading of virus

11. THANK YOU