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Advanced Neurology SARS-CoV-2 mechanisms of neurological impact

Table 5. Potential therapeutic approaches for managing neurological complications of COVID‑19
Neurological Proposed therapeutic approach Mechanism of action Current status References
condition
Cognitive impairment Repurposing Alzheimer’s disease Targets glutamatergic pathways to Speculative; Currently under 190-194
drugs (e.g., aminoadamantane, reduce excitotoxicity, potentially investigation for their potential efficacy
memantine) improving cognitive function in mitigating COVID-19-related
cognitive deficits
Hyperbaric oxygen therapy Improves cerebral perfusion Promising case studies; requires 195-198
and oxygen delivery, promotes larger trials to validate benefits for
neurogenesis and angiogenesis, and post-COVID-19 cognitive impairment
restores erythrocyte metabolism
Neuroinflammation Immune-modulating therapies Regulates the inflammatory Early promise in reducing cognitive 159,199-201
(e.g., JAK inhibitors like response, particularly impairment; clinical trials ongoing to
baricitinib, anti-IL-6, and cytokine storms, and reduces determine safety and efficacy
anti-IL-1β treatments) neuroinflammation by targeting key
inflammatory mediators
Natural compounds (e.g., Potentially reduces long-term Experimental stage; larger studies are 202
quercetin, ginkgolide, bilobalide) neuroinflammation and needed to establish their therapeutic
cognitive complications potentials
through neuroprotective and
anti-inflammatory properties
Stroke (ischemic and Established stroke interventions Maintains reperfusion and reduces Standard care remains effective for 86,203,204
hemorrhagic) (e.g., thrombolysis, clot burden in ischemic events COVID‑19 patients; no significant
thrombectomy) related to COVID-19. differences in outcomes compared to
stroke management for non-COVID-19
patients
Encephalopathy Corticosteroids (e.g., Reduces inflammation and Reported benefits in clinical practice, 205-208
methylprednisolone), IVIG, modulates immune responses to but further evidence is required
plasma exchange, rituximab address acute brain dysfunction and to confirm their effectiveness for
altered mental states in COVID-19 COVID-19-related encephalopathy
Guillain–Barré IVIG and plasma exchange Standard treatments to mitigate Established care for GBS applies to 209
syndrome progression, particularly in cases COVID‑19‑related cases; ongoing
with respiratory insufficiency that is monitoring of outcomes is essential
disproportionate to the pulmonary
findings
General Development of tailored Focuses on preventing Represents a key area of future 210
neuroprotection neuroprotective interventions long-term neurological damage research, with an emphasis on
while minimizing the risk of personalized therapeutic strategies
overtreatment in low-risk patients
Abbreviations: COVID‑19: Coronavirus disease 2019; GBS: Guillain–Barré syndrome; IL‑1β: Interleukin 1 beta; IL‑6: Interleukin‑6; IVIG: Intravenous
immunoglobulin; JAK: Janus kinase.

are crucial for brain tissue repair (Table 5). 196,197 A recent target inflammatory processes are being explored for their
case report highlighted the benefits of HBOT in a patient potential to reduce CI. Cytokine antagonists and pathway
199
with post-COVID-19 CI, noting improvements in modulators, such as Janus kinase inhibitors like baricitinib,
cerebral perfusion and the preservation of white matter have shown early promise in this context. These drugs aim
microarchitecture in regions such as the frontal, parietal, to regulate the intense inflammatory response, often referred
and limbic areas. This suggests that HBOT may promote to as a cytokine storm, which characterizes severe cases of
198
200
neurogenesis and angiogenesis, aiding cognitive recovery COVID-19. Therapies targeting specific inflammatory
in COVID-19 survivors. mediators, such as anti-IL-6 and anti-IL-1β treatments, are
being investigated for their ability to modulate cytokine
8.3. Neuroinflammation and immune-modulating activity and may help prevent cognitive decline after
therapies COVID-19 (Table 5). 201

Neuroinflammation is believed to play a significant role In addition, natural compounds with neuroprotective
in brain injury following COVID‑19. Consequently, properties, such as quercetin, ginkgolide, and bilobalide,
159
immune-modulating therapies that can cross the BBB and are under consideration for their potential to reduce

Volume 4 Issue 2 (2025) 24 doi: 10.36922/an.4909