Neurological manifestation of COVID – 19: a literature review

Ieva Jonušaitė1

1Vilnius University, Faculty of Medicine


Background. It is believed that nervous system involvement for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is as common as for its predecessors.

Aim. To evaluate the pathogenesis, clinical features, risk factors of the neurologic manifestation of Coronavirus disease 2019 (COVID – 19) and to specify the classification system which could be used in clinical practice.

Methods. The literature research in PubMed and Google Scholar data basis was performed of review articles, clinical cases and scientific researches to determine the neurologic manifestation of COVID – 19. The keywords used in the search were: “COVID-19”, “delirium”, “ischemic stroke”, “NEUROCOVID”, “SARS-CoV-2”. Only articles written in English were selected.

Results. Coronaviruses enter the nervous system through the cribriform plate, olfactory bulb, or by trans-synaptic dissemination. Neurological symptoms of COVID-19 caused by SARS-CoV-2 can be divided into three main groups: central (headache, dizziness, impaired consciousness, ataxia, seizures, focal neurologic deficits), peripheral (hypogeusia, hyposmia), or neuromuscular system (neuropathy). SARS-CoV-2 may affect the respiratory centre in the medulla oblongata and cause hypoventilation syndrome of central origin. The hypercoagulative status which results in arterial or venous thrombosis is also related to COVID-19. Hypertension, impairment of glucose tolerance or diabetes mellitus, obesity – were identified as factors that increase the risk for the development of cerebrovascular events to COVID – 19 patients. Scientists of the USA provide the three stages classification of “Neuro – COVID”, which allows following the progression of neurological symptoms.

Conclusions. Further clinical studies are needed to identify whether the neurological manifestation of COVID-19 is significant to the severity or clinical form of the disease, does it increase the risk of respiratory failure or death. It is strongly recommended to pay attention to risk factors of delirium, cerebrovascular events for COVID-19 patients and to use “NeuroCovid Staging” in clinical practice.

Keywords: COVID-19; delirium; ischemic stroke; NEUROCOVID; SARS-CoV-2.