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THE EVOLUTION AND TREATMENT OPTIONS OF PATIENTS WITH COVID-19 AND NEUROLOGICAL MANIFESTATIONS – A NARRATIVE REVIEW

IRINA ODAJIU 1, DRAGOȘ SANDU 1, EUGENIA IRENE DAVIDESCU 1,2*, BOGDAN OVIDIU POPESCU 1,2,3

1Neurology Department, Colentina Clinical Hospital, Bucharest, Romania
2“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3Laboratory of Cell Biology, Neurosciences and Experimental Myology, “Victor Babeș” National Institute of Pathology, Bucharest, Romania
4“Matei Balș” National Institute of Infectious Diseases, Bucharest, Romania

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COVID-19 is a multisystem disease with considerable heterogeneity of manifestations, including neurological. Neurological manifestations occur in up to 2/3 of patients in the acute phase and include non-specific, central nervous system and peripheral nervous system disorders. This is potentially explained because the SARS-CoV-2 virus has neuroinvasive properties, either directly by retrograde transport via nerve terminations or hematogenous dissemination, and induces neuroinflammation. The persistence of the SARS-CoV-2 in the nervous tissue for an extended period combined with secondary changes determined by neuroinflammation and hypoxia could be potential explanatory mechanisms for the long- COVID neurological manifestations, which occur even more often than those in the acute phase of COVID-19. Since available specialized therapies against neurological manifestations are still lacking, existing treatment options directed against viral invasiveness, the effects of immune dysregulation and hypercoagulable state, along with supportive measures to combat hypoxia, could serve as an efficient treatment for patients with COVID-19 and neurological manifestations. By preventing the SARS-CoV-2 from affecting the nervous tissue in the acute phase, it could also be possible to avoid long- COVID neurological impairment and probably the potential development of neurodegenerative diseases.