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Advanced Neurology Neurological complications of COVID-19

reported that patients with chronic hypoxemia, such as A number of possible mechanisms underlying muscle
obstructive sleep apnea and chronic obstructive pulmonary injury in COVID-19 patients have been proposed, such as:
disease, often experience cognitive decline, and chronic (i) increased oxidative stress caused by COVID-19; (ii) the
hypoxemia is also common in patients with COVID-19 . abuse of medications; and (iii) being bedridden and lack of
[25]
To fight against chronic hypoxemia, sedatives are often exercises. Malnutrition or inflammation is the main cause
used to facilitate invasive mechanical ventilation; however, of increased secretion of cytokine in COVID-19 patients,
the use of sedatives is commonly associated with high risk and excessive cytokines can lead to skeletal muscle
of acute phase brain decline. A multi-center study found damage and rhabdomyolysis [36,37] . These cytokines can also
that excessive sedation in response to COVID-19 was reduce the production of testosterone, a hormone which
[38]
associated with an increase in incidence of delirium in the promotes muscular integrity . Some antiviral drugs
infected patients . such as hydroxychloroquine and medications, which are
[21]
used to treat critical patients with COVID-19, were also
Inflammation often leads to brain dysfunction with found to damage muscles , and this effect was more
[39]
the aid of pro-inflammatory cytokines and inflammatory pronounced in inactive patients. In addition, intubation
mediators, which are abundant in the blood and brain . and mechanical ventilation used in the treatment of
[26]
The pro-inflammatory cytokines disrupt the blood-brain COVID-19 patients as well as long hours of bed rest could
barrier permeability by increasing the cyclooxygenase-2 contribute to significant muscle loss . A few reports have
[40]
expression and activating matrix metalloproteinase . suggested that SARS-CoV-2 can directly induce muscle
[27]
In addition, the microglial activation and oxidative stress toxicity in the infected patients . A Chinese study on
[39]
caused by the pro-inflammatory cytokines lead to short- 1014 hospitalized COVID-19 patients showed that those
term delirium and severe long-term cognitive impairment. with rhabdomyolysis were susceptible to a higher risk
An electroencephalogram (EEG) study found that higher of deterioration and had a higher mortality rate than
regional current density at delta band was correlated with those without rhabdomyolysis . COVID-19 is believed
[41]
worse executive performances in COVID-19 patients . to exacerbate pre-existing motor impairments, such as
[28]
A follow-up study also found that lower EEG delta band at those in infected patients with Parkinson’s disease. In a
baseline predicted worse cognitive performance. Further, study on 694 COVID-19 patients, it is found that patients
a neuroimaging study found that COVID-19 patients with Parkinson’s disease have a higher mortality rate
showed poorer hypometabolism predominantly in the than patients without the disease (95% CI 1.04–1.53) .
[42]
frontoparietal network, and this neuroimaging patterns Therefore, early diagnosis and intervention are necessary
showed a high correlation (R = 0.62) with the Montreal in patients with poor baseline underlying conditions.
2
Cognitive Assessment performance .
[29]
2.4. Cerebrovascular diseases
2.3. Muscle injury and movement disorders
Acute ischemic stroke is a dangerous complication of
Muscle injury and movement disorders are among the COVID-19. The coincidences of ischemic stroke reported
complications associated with COVID-19. Some patients in hospitalized COVID-19 patients range from 1% to 5%,
showed fatigue, muscle soreness, and elevated muscle and patients with more severe infection had a higher risk
enzyme levels . Another study also reported that the of stroke [43,44] ; however, the occurrence rate of hemorrhagic
[30]
creatine kinase level in 15.7% of hospitalized COVID- cerebrovascular disease was lower than 1%. A meta-
19 patients increased dramatically . In addition, a analysis reported that ischemic stroke occurred in 1.5% of
[31]
meta-analysis on 1100 studies found that around 34.7% COVID-19 patients (95% CI 0.9–3.7%), and the in-hospital
of COVID-19 patients showed symptoms of myalgia or mortality rate was 34.4% (95% CI 27.2–42.4%) .
[45]
fatigue (95% CI 26.0–44.4) . In addition, a meta-analysis Furthermore, a study on influenza (n = 1486) or COVID-
[32]
involving 3062 hospitalized COVID-19 patients reported 19 (n = 1916) patients found that COVID-19 patients had
that the patients suffered from muscle soreness, which was a higher risk of stroke (95% CI 2.3–25.2) compared to
[33]
the third most common symptom after fever and cough . influenza patients . The pathogenic pathways underlying
[46]
Besides, the associated symptoms in discharged patients are the development of ischemic stroke vary between patients
also noteworthy. In a longitudinal follow-up study, fatigue with and without COVID-19, and COVID-19 patients had
and muscle weakness were the most common sequelae worse prognosis. Another report also showed that stroke
(63%, 1038 of 1655) . Furthermore, a comprehensive patients with COVID-19 took longer time for recovery and
[34]
health assessment after 3 months of rehabilitation found were more likely to have higher mortality rate and worse
that 22% and 64% of COVID-19 survivors had poor baseline neurological test scores . It is noteworthy that
[47]
exercise capacity and muscle fatigue, respectively . the risk factors of ischemic stroke in COVID-19 patients
[35]
Volume 1 Issue 2 (2022) 3 https://doi.org/10.36922/an.v1i2.83