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1.
CNS Neurol Disord Drug Targets ; 20(5): 390-391, 2021.
Article in English | MEDLINE | ID: covidwho-1526729

ABSTRACT

A letter to the editor to discuss several uses of brain magnetic resonance imaging (MRI) in the investigation of neurological manifestations of covid-19. Described several situations in which the MRI is needed. Brain MRI is an important diagnostic method in the covid-19 scenario, to investigate possible neurological complications of the disease.


Subject(s)
COVID-19/complications , COVID-19/diagnostic imaging , Magnetic Resonance Imaging/methods , Nervous System Diseases/diagnostic imaging , Nervous System Diseases/etiology , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/etiology , Headache/diagnostic imaging , Headache/etiology , Humans
2.
Int J Mol Sci ; 22(8)2021 Apr 15.
Article in English | MEDLINE | ID: covidwho-1186972

ABSTRACT

COVID-19 is a severe respiratory disease caused by the newly identified human coronavirus (HCoV) Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The virus was discovered in December 2019, and in March 2020, the disease was declared a global pandemic by the World Health Organization (WHO) due to a high number of cases. Although SARS-CoV-2 primarily affects the respiratory system, several studies have reported neurological complications in COVID-19 patients. Headache, dizziness, loss of taste and smell, encephalitis, encephalopathy, and cerebrovascular diseases are the most common neurological complications that are associated with COVID-19. In addition, seizures, neuromuscular junctions' disorders, and Guillain-Barré syndrome were reported as complications of COVID-19, as well as neurodegenerative and demyelinating disorders. However, the management of these conditions remains a challenge. In this review, we discuss the prevalence, pathogenesis, and mechanisms of these neurological sequelae that are secondary to SARS-CoV-2 infection. We aim to update neurologists and healthcare workers on the possible neurological complications associated with COVID-19 and the management of these disease conditions.


Subject(s)
COVID-19/complications , Nervous System Diseases/drug therapy , Nervous System Diseases/etiology , Central Nervous System/drug effects , Central Nervous System/virology , Cerebrovascular Disorders/drug therapy , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/virology , Humans , Nervous System Diseases/epidemiology , Nervous System Diseases/virology , Prevalence , SARS-CoV-2/metabolism
4.
J Cereb Blood Flow Metab ; 41(6): 1179-1192, 2021 06.
Article in English | MEDLINE | ID: covidwho-1061015

ABSTRACT

Cerebrovascular events have emerged as a central feature of the clinical syndrome associated with Sars-CoV-2 infection. This increase in infection-related strokes is marked by atypical presentations including stroke in younger patients and a high rate of hemorrhagic transformation after ischemia. A variety of pathogenic mechanisms may underlie this connection. Efforts to identify synergism in the pathophysiology underlying stroke and Sars-CoV-2 infection can inform the understanding of both conditions in novel ways. In this review, the molecular cascades connected to Sars-CoV-2 infection are placed in the context of the cerebral vasculature and in relationship to pathways known to be associated with stroke. Cytokine-mediated promotion of systemic hypercoagulability is suggested while direct Sars-CoV-2 infection of cerebral endothelial cells may also contribute. Endotheliopathy resulting from direct Sars-CoV-2 infection of the cerebral vasculature can modulate ACE2/AT1R/MasR signaling pathways, trigger direct viral activation of the complement cascade, and activate feed-forward cytokine cascades that impact the blood-brain barrier. All of these pathways are already implicated as independent mechanisms driving stroke and cerebrovascular injury irrespective of Sars-CoV-2. Recognizing the overlap of molecular pathways triggered by Sars-CoV-2 infection with those implicated in the pathogenesis of stroke provides an opportunity to identify future therapeutics targeting both Sars-CoV-2 and stroke thereby reducing the impact of the global pandemic.


Subject(s)
COVID-19/pathology , Cerebrovascular Disorders/etiology , Stroke/etiology , Angiotensin-Converting Enzyme 2/metabolism , Blood-Brain Barrier/metabolism , COVID-19/complications , COVID-19/virology , Cerebrovascular Disorders/metabolism , Complement Activation , Humans , Renin-Angiotensin System , Spike Glycoprotein, Coronavirus/metabolism , Stroke/metabolism , Virus Internalization
5.
Stroke ; 51(12): 3719-3722, 2020 12.
Article in English | MEDLINE | ID: covidwho-1050419

ABSTRACT

BACKGROUND AND PURPOSE: Case series indicating cerebrovascular disorders in coronavirus disease 2019 (COVID-19) have been published. Comprehensive workups, including clinical characteristics, laboratory, electroencephalography, neuroimaging, and cerebrospinal fluid findings, are needed to understand the mechanisms. METHODS: We evaluated 32 consecutive critically ill patients with COVID-19 treated at a tertiary care center from March 9 to April 3, 2020, for concomitant severe central nervous system involvement. Patients identified underwent computed tomography, magnetic resonance imaging, electroencephalography, cerebrospinal fluid analysis, and autopsy in case of death. RESULTS: Of 32 critically ill patients with COVID-19, 8 (25%) had severe central nervous system involvement. Two presented with lacunar ischemic stroke in the early phase and 6 with prolonged impaired consciousness after termination of analgosedation. In all but one with delayed wake-up, neuroimaging or autopsy showed multiple cerebral microbleeds, in 3 with additional subarachnoid hemorrhage and in 2 with additional small ischemic lesions. In 3 patients, intracranial vessel wall sequence magnetic resonance imaging was performed for the first time to our knowledge. All showed contrast enhancement of vessel walls in large cerebral arteries, suggesting vascular wall pathologies with an inflammatory component. Reverse transcription-polymerase chain reactions for SARS-CoV-2 in cerebrospinal fluid were all negative. No intrathecal SARS-CoV-2-specific IgG synthesis was detectable. CONCLUSIONS: Different mechanisms of cerebrovascular disorders might be involved in COVID-19. Acute ischemic stroke might occur early. In a later phase, microinfarctions and vessel wall contrast enhancement occur, indicating small and large cerebral vessels involvement. Central nervous system disorders associated with COVID-19 may lead to long-term disabilities. Mechanisms should be urgently investigated to develop neuroprotective strategies.


Subject(s)
COVID-19/diagnostic imaging , Cerebral Arteries/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Cerebrovascular Disorders/diagnostic imaging , Ischemic Stroke/diagnostic imaging , Aged , Antibodies, Viral/cerebrospinal fluid , Brain Ischemia/diagnostic imaging , Brain Ischemia/etiology , COVID-19/cerebrospinal fluid , COVID-19/complications , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Cerebral Hemorrhage/etiology , Cerebrospinal Fluid/immunology , Cerebrospinal Fluid/virology , Cerebrovascular Disorders/cerebrospinal fluid , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/physiopathology , Consciousness Disorders/etiology , Consciousness Disorders/physiopathology , Contrast Media , Critical Illness , Electroencephalography , Female , Humans , Ischemic Stroke/etiology , Magnetic Resonance Imaging , Male , Middle Aged , SARS-CoV-2 , Severity of Illness Index , Switzerland , Tertiary Care Centers , Tomography, X-Ray Computed
6.
CNS Neurol Disord Drug Targets ; 20(5): 390-391, 2021.
Article in English | MEDLINE | ID: covidwho-1042027

ABSTRACT

A letter to the editor to discuss several uses of brain magnetic resonance imaging (MRI) in the investigation of neurological manifestations of covid-19. Described several situations in which the MRI is needed. Brain MRI is an important diagnostic method in the covid-19 scenario, to investigate possible neurological complications of the disease.


Subject(s)
COVID-19/complications , COVID-19/diagnostic imaging , Magnetic Resonance Imaging/methods , Nervous System Diseases/diagnostic imaging , Nervous System Diseases/etiology , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/etiology , Headache/diagnostic imaging , Headache/etiology , Humans
7.
J Mol Neurosci ; 71(11): 2192-2209, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1037256

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is an issue of global significance that has taken the lives of many across the world. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for its pathogenesis. The pulmonary manifestations of COVID-19 have been well described in the literature. Initially, it was thought to be limited to the respiratory system; however, we now recognize that COVID-19 also affects several other organs, including the nervous system. Two similar human coronaviruses (CoV) that cause severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) are also known to cause disease in the nervous system. The neurological manifestations of SARS-CoV-2 infection are growing rapidly, as evidenced by several reports. There are several mechanisms responsible for such manifestations in the nervous system. For instance, post-infectious immune-mediated processes, direct virus infection of the central nervous system (CNS), and virus-induced hyperinflammatory and hypercoagulable states are commonly involved. Guillain-Barré syndrome (GBS) and its variants, dysfunction of taste and smell, and muscle injury are numerous examples of COVID-19 PNS (peripheral nervous system) disease. Likewise, hemorrhagic and ischemic stroke, encephalitis, meningitis, encephalopathy acute disseminated encephalomyelitis, endothelialitis, and venous sinus thrombosis are some instances of COVID-19 CNS disease. Due to multifactorial and complicated pathogenic mechanisms, COVID-19 poses a large-scale threat to the whole nervous system. A complete understanding of SARS-CoV-2 neurological impairments is still lacking, but our knowledge base is rapidly expanding. Therefore, we anticipate that this comprehensive review will provide valuable insights and facilitate the work of neuroscientists in unfolding different neurological dimensions of COVID-19 and other CoV associated abnormalities.


Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , Pandemics , SARS-CoV-2/pathogenicity , Adolescent , Adult , Angiotensin-Converting Enzyme 2/physiology , Asymptomatic Infections , Autoimmune Diseases of the Nervous System/etiology , Blood-Brain Barrier , COVID-19/immunology , COVID-19/physiopathology , Cerebrovascular Disorders/etiology , Child , Communicable Diseases, Emerging , Coronavirus Infections/complications , Humans , Hypoxia/etiology , Hypoxia/physiopathology , Nervous System/virology , Nervous System Diseases/immunology , Nervous System Diseases/physiopathology , Organ Specificity , Receptors, Virus/physiology , Severe Acute Respiratory Syndrome/complications , Synapses/virology , Viral Tropism , Young Adult
8.
J Stroke Cerebrovasc Dis ; 30(1): 105454, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1023683

ABSTRACT

OBJECTIVES: COVID-19 disproportionately affects older adults and individuals with cardiovascular co-morbidities. This report presents fifteen patients who had COVID-19 respiratory illness followed by cerebrovascular events. MATERIALS AND METHODS: A call by the Iranian Neurological Association gathered cases across the country who developed neurological symptoms attributed to hemorrhagic or ischemic stroke after a definite or probable Covid-19 respiratory illness. Definite cases were those with a typical respiratory illness, positive nasopharyngeal Covid-19 PCR test, and chest CT consistent with Covid-19 infection. Probable cases were defined by a typical respiratory illness, history of contacts with a Covid-19 case, and chest CT characteristic for Covid-19 infection. RESULTS: Fifteen patients (12 men and 3 women) with an age range of 38 to 93 years old (median: 65 years old) were included. Fourteen patients had a first-ever acute ischemic stroke and one patient had a subarachnoid hemorrhage. Eleven patients (73%) had previous cardiovascular comorbidities. The median time between respiratory symptoms and neurological symptoms was seven days (range 1-16 days). Stroke severity in two patients was mild (NIHSS ≤ 6), in six patients moderate (NIHSS: 7-12), and in seven patients severe (NIHSS ≥13). One patient received intravenous tissue plasminogen activator ( IV-tPA) with improved neurological symptoms. Six out of 15 patients (40%) died. All but one of those who survived had significant disability assessed by a modified ranking scale >2. The majority of patients in this case series had vascular risk factors and their stroke was associated with severe disability and death. CONCLUSION: This report highlights the need for further investigation of the links between Covid-19 and cerebrovascular events.


Subject(s)
COVID-19/complications , Cerebrovascular Disorders/etiology , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/mortality , Cerebrovascular Disorders/therapy , Disability Evaluation , Female , Humans , Iran , Male , Middle Aged , Recovery of Function , Risk Factors , Severity of Illness Index , Thrombolytic Therapy , Treatment Outcome
10.
Anaesth Crit Care Pain Med ; 39(3): 351-353, 2020 06.
Article in English | MEDLINE | ID: covidwho-986871
13.
Biomedica ; 40(Supl. 2): 173-179, 2020 10 30.
Article in English, Spanish | MEDLINE | ID: covidwho-914758

ABSTRACT

Coronaviruses cause respiratory and gastrointestinal disorders in animals and humans. The current SARS-CoV-2, the COVID-19 infectious agent, belongs to a subgroup called betacoronavirus including the SARS-CoV and MERS-CoV responsible for epidemics in 2002 and 2012, respectively. These viruses can also infect the nervous system due to their affinity for the human angiotensin-converting enzyme 2 (ACE2) expressed in neurons and glial cells. Infections with SARS-CoV, MERS-CoV, and now SARS-CoV-2 also produce neurological signs such as acute cerebrovascular disease, impaired consciousness, and muscle injury, as well as dizziness, hypogeusia, hyposmia, hypoxia, neuralgia, and hypoxic encephalopathy. For this reason, close attention should be paid to the neurological manifestations of COVID-19 patients.


Los coronavirus son una familia de virus que se caracterizan por producir afectaciones respiratorias y gastrointestinales en animales y en seres humanos. El actual SARS-CoV-2, agente infeccioso de la COVID-19, pertenece a un subgrupo denominado betacoronavirus del que hacen parte el SARS-CoV y MERS-CoV, virus responsables de epidemias en el 2002 y el 2012, respectivamente. Estos virus también pueden infectar el sistema nervioso debido a su afinidad con la enzima convertidora de angiotensina humana 2 (ACE2), la cual se expresa en neuronas y células gliales. Se ha demostrado que las infecciones con SARS-CoV y MERS-CoV, y ahora también con el SARS-CoV-2, ocasionan condiciones neurológicas como la enfermedad cerebrovascular aguda, la conciencia alterada y las lesiones musculares, así como mareos, hipogeusia, hiposmia, hipoxia, neuralgia y encefalopatía hipóxica. Por ello debe prestarse mucha atención a las manifestaciones neurológicas de los pacientes de COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Middle East Respiratory Syndrome Coronavirus/pathogenicity , Nervous System Diseases/etiology , Pneumonia, Viral/complications , SARS Virus/pathogenicity , Severe Acute Respiratory Syndrome/complications , COVID-19 , Cerebrospinal Fluid/virology , Cerebrovascular Disorders/etiology , Consciousness Disorders/etiology , Coronavirus Infections/epidemiology , Disease Outbreaks , Forecasting , Humans , Musculoskeletal Diseases/etiology , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome/etiology , SARS-CoV-2 , Sensation Disorders/etiology , Severe Acute Respiratory Syndrome/epidemiology , Virus Latency
14.
J Stroke Cerebrovasc Dis ; 30(1): 105427, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-899242

ABSTRACT

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been shown to cause multisystemic damage. We undertook a systematic literature review and comprehensive analysis of a total of 55 articles on arterial and venous thromboembolism in COVID-19 and articles on previous pandemics with respect to thromboembolism and compared the similarities and differences between them. The presence of thrombosis in multiple organ systems points to thromboembolism being an integral component in the pathogenesis of this disease. Thromboembolism is likely to be the main player in the morbidity and mortality of COVID -19 in which the pulmonary system is most severely affected. We also hypothesize that D-dimer values could be used as an early marker for prognostication of disease as it has been seen to be raised even in the pre-symptomatic stage. This further strengthens the notion that thromboembolism prevention is necessary. We also examined literature on the neurovascular and cardiovascular systems, as the manifestation of thromboembolic phenomenon in these two systems varied, suggesting different pathophysiology of damage. Further research into the role of thromboembolism in COVID-19 is important to advance the understanding of the virus, its effects and to tailor treatment accordingly to prevent further casualties from this pandemic.


Subject(s)
Arterial Occlusive Diseases/etiology , COVID-19/complications , Cerebrovascular Disorders/etiology , Pulmonary Embolism/etiology , Venous Thromboembolism/etiology , Venous Thrombosis/etiology , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/mortality , Arterial Occlusive Diseases/prevention & control , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/mortality , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/mortality , Cerebrovascular Disorders/prevention & control , Fibrinolytic Agents/therapeutic use , Humans , Prognosis , Pulmonary Embolism/diagnosis , Pulmonary Embolism/mortality , Pulmonary Embolism/prevention & control , Risk Assessment , Risk Factors , Venous Thromboembolism/diagnosis , Venous Thromboembolism/mortality , Venous Thromboembolism/prevention & control , Venous Thrombosis/diagnosis , Venous Thrombosis/mortality , Venous Thrombosis/prevention & control
15.
Brain Inj ; 34(12): 1549-1568, 2020 10 14.
Article in English | MEDLINE | ID: covidwho-872817

ABSTRACT

OBJECTIVE: Following the outbreak of coronavirus 2019 (COVID-19), there is strong evidence of neurological involvement in these patients. We aimed to determine the clinical characteristics of neurological manifestations in COVID-19. METHOD: A systematic review of studies reporting neurological manifestations published between 1 December, 2019 and 11 May, 2020 was performed. Studies were grouped based on neurological manifestation. Pooled analyses of individual patient's clinical characteristics and olfactory and gustatory dysfunction prevalence were performed. RESULTS: Of 486 studies identified, 48 were included. 70 patients with 73 neurological manifestations were reported. 39 (53.4%) patients had stroke, 18 (24.7%) had Guillain-Barré syndrome and variants, 11 (15.1%) had meningitis, encephalitis, encephalopathy, or myelitis, and five (6.8%) had seizures. They had a mean age of 61.9 ± 17.7 years (60.6% male). Neurological disease occurred 8.1 ± 6.8 days from initial symptoms. Average mortality rate was 17.8%. Stroke has a mortality rate of 25.6%. Olfactory and gustatory dysfunction occurred in 59.9% and 57.5%, respectively. CONCLUSIONS: Stroke is the most frequently reported neurological manifestation in COVID-19 and has the highest mortality rate. Neurological manifestations tend to develop one to two weeks after the onset of respiratory disease. There is significant morbidity and mortality associated with COVID-19 neurological manifestations.


Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , Cerebrovascular Disorders/etiology , Encephalitis/etiology , Guillain-Barre Syndrome/etiology , Humans
16.
Brain Nerve ; 72(10): 1039-1043, 2020 Oct.
Article in Japanese | MEDLINE | ID: covidwho-869292

ABSTRACT

Cerebrovascular disease and vasculitis-related diseases have been reported as systemic complications of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A proposed underlying mechanism is that SARS-CoV-2 infects vascular endothelial cells via the angiotensin-converting enzyme 2 (ACE2) and causes inflammation. Cerebrovascular disease and vasculitis are often observed in severe COVID-19 cases, and they may be associated with critical systemic conditions, such as the cytokine storm and thrombotic tendencies. Several other mechanisms have been proposed, and diverse pathological conditions may be associated with COVID-19-related cerebrovascular disease and vasculitis. Clarifying the pathophysiology and establishing a better therapeutic regimen will facilitate favorable outcomes.


Subject(s)
Cerebrovascular Disorders , Coronavirus Infections , Pandemics , Pneumonia, Viral , Vasculitis , Betacoronavirus , COVID-19 , Cerebrovascular Disorders/etiology , Coronavirus Infections/complications , Endothelial Cells , Humans , Pneumonia, Viral/complications , SARS-CoV-2 , Vasculitis/etiology
17.
Int J Stroke ; 16(4): 437-447, 2021 06.
Article in English | MEDLINE | ID: covidwho-806135

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. AIM: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. METHODS: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020-16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). RESULTS: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130-280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. CONCLUSIONS: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.


Subject(s)
COVID-19/epidemiology , Cerebrovascular Disorders/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/therapy , Cohort Studies , Female , Hospital Mortality , Humans , Intracranial Hemorrhages/epidemiology , Ischemic Stroke/epidemiology , Ischemic Stroke/etiology , Ischemic Stroke/therapy , Lymphocyte Count , Male , Middle Aged , Prevalence , Registries , Retrospective Studies , Risk Factors , Sex Factors , Thrombosis/etiology , Tobacco Use , Young Adult
18.
Int J Mol Sci ; 21(12)2020 Jun 17.
Article in English | MEDLINE | ID: covidwho-738129

ABSTRACT

Exposure to ambient air pollution is a well-established determinant of health and disease. The Lancet Commission on pollution and health concludes that air pollution is the leading environmental cause of global disease and premature death. Indeed, there is a growing body of evidence that links air pollution not only to adverse cardiorespiratory effects but also to increased risk of cerebrovascular and neuropsychiatric disorders. Despite being a relatively new area of investigation, overall, there is mounting recent evidence showing that exposure to multiple air pollutants, in particular to fine particles, may affect the central nervous system (CNS) and brain health, thereby contributing to increased risk of stroke, dementia, Parkinson's disease, cognitive dysfunction, neurodevelopmental disorders, depression and other related conditions. The underlying molecular mechanisms of susceptibility and disease remain largely elusive. However, emerging evidence suggests inflammation and oxidative stress to be crucial factors in the pathogenesis of air pollution-induced disorders, driven by the enhanced production of proinflammatory mediators and reactive oxygen species in response to exposure to various air pollutants. From a public health perspective, mitigation measures are urgent to reduce the burden of disease and premature mortality from ambient air pollution.


Subject(s)
Air Pollutants/adverse effects , Air Pollutants/analysis , Air Pollution/adverse effects , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/metabolism , Mental Disorders/etiology , Mental Disorders/metabolism , Oxidative Stress , Animals , COVID-19/complications , COVID-19/epidemiology , Cerebrovascular Disorders/epidemiology , Disease Models, Animal , Disease Susceptibility , Global Health , Humans , Inflammation , Mental Disorders/epidemiology , Particulate Matter/adverse effects
19.
Stroke ; 51(9): e227-e231, 2020 09.
Article in English | MEDLINE | ID: covidwho-695959

ABSTRACT

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection. METHODS: Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior. RESULTS: Eighty-six COVID-19-positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P<0.001), mortality (29.1% versus 9.0%; P<0.001), and Black/multiracial race (58.1% versus 36.9%; P=0.001). COVID-19 was the strongest independent risk factor for in-hospital stroke (odds ratio, 20.9 [95% CI, 10.4-42.2]; P<0.001), whereas COVID-19, older age, and intracranial hemorrhage independently predicted mortality. CONCLUSIONS: COVID-19 is an independent risk factor for stroke in hospitalized patients and mortality, and stroke presentations are frequently atypical.


Subject(s)
Cerebrovascular Disorders/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Adult , Age Factors , Aged , Aged, 80 and over , Brain Ischemia/etiology , Brain Ischemia/therapy , COVID-19 , Cerebral Angiography , Cerebrovascular Disorders/mortality , Cerebrovascular Disorders/therapy , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Female , Hospital Mortality , Humans , Intracranial Hemorrhages/complications , Intracranial Hemorrhages/mortality , Male , Middle Aged , Neuroimaging , New York/epidemiology , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Retrospective Studies , Risk Factors , Stroke/etiology , Stroke/therapy , Treatment Outcome
20.
Can J Neurol Sci ; 48(1): 9-24, 2021 01.
Article in English | MEDLINE | ID: covidwho-697107

ABSTRACT

BACKGROUND: Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations. METHODS: PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: "COVID-19", "SARS-CoV-2", "pandemic", "neuro-COVID", "stroke-COVID", "epilepsy-COVID", "COVID-encephalopathy", "SARS-CoV-2-encephalitis", "SARS-CoV-2-rhabdomyolysis", "COVID-demyelinating disease", "neurological manifestations", "psychosocial manifestations", "treatment recommendations", "COVID-19 and therapeutic changes", "psychiatry", "marginalised", "telemedicine", "mental health", "quarantine", "infodemic" and "social media". A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context. RESULTS: Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes. CONCLUSION: Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.


Subject(s)
COVID-19/physiopathology , Nervous System Diseases/physiopathology , Ageusia/etiology , Ageusia/physiopathology , Alzheimer Disease/therapy , Angiotensin-Converting Enzyme 2 , Anosmia/etiology , Anosmia/physiopathology , Brain Diseases , COVID-19/complications , COVID-19/epidemiology , COVID-19/psychology , Cerebellar Ataxia/etiology , Cerebellar Ataxia/physiopathology , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/physiopathology , Comorbidity , Delivery of Health Care , Demyelinating Diseases/therapy , Disease Management , Dizziness/etiology , Dizziness/physiopathology , Epilepsy/therapy , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Headache/etiology , Headache/physiopathology , Humans , Hypoxia, Brain/physiopathology , Inflammation/physiopathology , Meningoencephalitis/etiology , Meningoencephalitis/physiopathology , Muscular Diseases/etiology , Muscular Diseases/physiopathology , Myelitis, Transverse/etiology , Myelitis, Transverse/physiopathology , Myoclonus/etiology , Myoclonus/physiopathology , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Parkinson Disease/therapy , Polyneuropathies/etiology , Polyneuropathies/physiopathology , SARS-CoV-2 , Seizures/etiology , Seizures/physiopathology , Stroke/therapy , Viral Tropism
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