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Advanced Neurology Neurological complications of COVID-19

may be associated with hypercoagulability under hypoxia of low molecular weight heparin or unitary heparin, is
state. In concordance with the above, a study demonstrated preferred for patients suffering from this complication .
[57]
that a considerable part of COVID-19 patients have It is important to note that RNA vaccination may increase
abnormal coagulation parameters, such as elevated levels the risk of cerebral venous sinus thrombosis. Moreover,
of d-dimer and C-reactive protein as well as positive lupus a German study has reported that the occurrence rate
anticoagulant test . Elevations in these factors may be of cerebral venous sinus thrombosis was 0.55 (95%
[48]
a sign of COVID-19-mediated damage to the nervous CI = 0.38–0.78) per 100,000 person-months, which was
[58]
system. This suggests that COVID-19 may directly higher than that in the general population . Therefore,
increase the risk of stroke through cerebral vasculitis. It the vaccination against COVID-19 is essential, given that it
has been found in another cohort that the patients were can reduce the risk of serious complications of COVID-19.
negative for lupus anticoagulant but positive for anti-
[49]
cardiolipin and anti-B2-glycoprotein antibodies . These 2.5. Other neurological complications
abnormal coagulation parameters may predict the risk In addition to the neurological complications mentioned
of cerebrovascular disease in COVID-19 patients, but, above, there are many other complications associated
further, investigations on the mechanisms underlying with COVID-19, such as epilepsy, meningitis, and
these abnormalities are warranted. demyelinating diseases.
The treatment with prophylactic anticoagulation may A growing number of case reports point out that
be beneficial to patients with COVID-19. According to the COVID-19 could exacerbate epilepsy in patients who already
recommendation of The American Society of Hematology, have the nervous disorder and, unfortunately, trigger epilepsy
hospitalized COVID-19 patients should be treated with in patients who do not at the same time suffer from the
standard thromboprophylaxis . Based on the findings of disorder [59,60] . Metabolic disorders, high fever, or electrolyte
[50]
randomized clinical trials, a full-dose anticoagulant therapy disarrangements caused by COVID-19 may be the cause of
[61]
may benefit the critically ill patients with COVID-19, but epilepsy . Therefore, electroencephalography monitoring of
at the same time, this treatment may increase the risk of severe COVID-19 patients is helpful for early diagnosis and
[51]
other complications . Thus, the prophylactic use of prevention of epilepsy, and early monitoring of patients with
[62]
anticoagulants as a treatment for critically ill patients symptoms of encephalopathy is also beneficial . COVID-
is still up for debate. Of note, the occurrence rate of 19 patients may develop symptoms of epilepsy before the onset
arterial or venous thromboembolism in hospitalized of respiratory symptoms, and the symptoms may include both
[63]
COVID-19 patients has been reported to be between 8% generalized tonic-clonic seizures and focal seizures . It is
and 31% despite the fact that prophylactic anticoagulant important to note that cases of epilepsy in pediatric COVID-
therapy was adopted [52,53] . A multicenter study conducted in 19 patients have been reported, although the exact cause of
[64]
Italy has reported that COVID-19 patients to whom stroke epilepsy is unknown . In short, epilepsy and seizures should
occurred despite the use of anticoagulant therapy had a be considered the underlying manifestations of COVID-19 in
worse clinical outcome, along with 64.7% of fatality rate . the pediatric patients.
[54]
The treatment for stroke is similarly administered to patients Symptoms of encephalitis have also been reported
with or without COVID-19; however, there are few studies in COVID-19 patients. SARS-CoV-2 has been found in
about the safety and feasibility of thrombectomy treatment the cerebrospinal fluid (CSF) of COVID-19 patients [65,66] ;
in COVID-19 patients with acute ischemic stroke. however, CSF of some COVID-19 patients with acute
Despite its rarity, cerebral venous thrombosis is meningoencephalitis was found to be free from SARS-
[67]
also a complication of COVID-19. Most patients with CoV-2 or other viral pathogens . This indicates that
cerebral venous thrombosis present with only nonspecific meningitis in the COVID-19 patients is not caused
symptoms, such as headache, fever, and visual problems, directly by brain infection, but by other factors, such as
which implies elevated intracranial pressure . A study inflammation during acute COVID-19 phase. Encephalitis
[55]
found that the median duration of onset in hospitalized can be complicated by intracerebral and subdural
COVID-19 patients across different countries was three hematoma, and it is either severely disabling or life-
days from COVID-19 diagnosis, and the superior sagittal threatening; therefore, infected individuals should be wary
sinus is the most common site of thrombosis . The of this possible complication following COVID-19.
[56]
diagnosis of cerebral venous sinus thrombosis is based Besides, the rare connection of COVID-19 with temporary
on clinical and radiological findings obtained from visual impairment has been reported, and the visual loss
magnetic resonance imaging (MRI) and venography. may be associated with cerebral vasculitis . In addition,
[68]
Heparin anticoagulant therapy, either at therapeutic doses demyelinating diseases such as Guillain–Barre syndrome

Volume 1 Issue 2 (2022) 4 https://doi.org/10.36922/an.v1i2.83