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Neurological & locomotor system affections of SARS-CoV2 COVID-19

Incidence: Neurological manifestation

Pathology

Virus enters through olfactory route -> Nervous system -> Replication in nasal cavity -> Demyelination & inflammation

Demyelination is the process in which nerves lose the myelin sheath coating around it thus interrupting the nerve conduction to & fro from the brain

Presentation Investigation
  • Loss of taste
  • Loss of smell (anosmia)
 Nerve conduction study- Delayed distal latencies and absent F waves in early course, supporting demyelinating neuropathy

Pathology

Triggered by immune response

Presentation Investigation
  • Dizziness
  • Headache
  • Vertigo
  • Nausea
  • Vomiting

Pathology

Direct infection by the virus or secondary to systemic inflammation (arise 5-10 days after first onset of COVID-19 symptoms)

Presentation Investigation
  • Confusion
  • Severe agitation
  • Guillian barre syndrome ( weakness, areflexia- absence of reflexes, paraesthesia, facial weakness, loss of balance, weakness & paralysis)
  • Lumbar puncture
  • Electromyography
  • Nerve conduction studies

Pathology

Injury to brain stem

Presentation Investigation
  • Depress respiratory centre
  • Difficulty in breathing
 CT & MRI reveal hemorrhagic lesions

Pathology

Blood clots- thrombosis (underlying thromboembolic disease)

Presentation Investigation
  • Strokes & cerebro vascular disease
  • Impaired consciousness
  • Confusion
  • Dizziness
  • Numbness
  • Inflammatory biomarkers including elevated levels of white blood cells, C-reactive protein, and D-dimers
  • Coagulation & prolonged prothrombin time

Pathology

Virus exploits the angiotensin-converting enzyme 2 (ACE2) receptor to gain entry inside the glial cells & neurons

Presentation Investigation
  • Meningeal irritation-headache
  • Meningitis
  • Encephalitis
Presence of SARS-CoV2 in CSF (marked cellular reaction, increased protein and positive PCR test)

Pathology

Triggered by fever -> Cytokinin storm -> Crossing over blood brain barrier

Presentation Investigation
Seizure in epileptic patients

Incidence: Locomotor system

Pathology

Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF- α) levels in plasma and upper respiratory secretions directly correlate with the magnitude of viral replication, fever, and respiratory and systemic symptoms, including musculoskeletal clinical manifestations