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Advanced Neurology SARS-CoV-2 mechanisms of neurological impact

long-term cognitive complications associated with 9. Long-term neuroimaging evidence of
COVID-19. However, the efficacy and safety of these structural and functional brain changes in
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interventions remain uncertain, and larger, well-designed COVID-19 survivors
clinical trials are needed to comprehensively evaluate
these therapies. 9.1. Acute phase neuroimaging findings
8.4. Stroke and seizure management: Adhering to Neuroimaging research has consistently identified brain
established standards of care abnormalities in both the acute and recovery phases of
COVID-19. 24,211-213 During the acute phase of the illness, MRI
COVID-19 has been linked to an increased risk of stroke, scans have detected signal abnormalities in approximately
with patients experiencing both ischemic and hemorrhagic one-third of patients, highlighting early neuroimaging
events due to the virus-induced prothrombotic markers of the disease. In addition, brain CT scans have
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state. Current evidence suggests that standard stroke revealed acute lesions, particularly in severe cases requiring
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interventions, such as thrombolysis or thrombectomy, intensive care unit admission, underscoring the severity of
remain applicable to COVID-19 patients, with no brain involvement in critical cases (Table 6). 214-218
significant differences in the risk-benefit ratio compared to As patients progress to the recovery phase, neuroimaging
non-COVID-19 stroke patients (Table 5). 203,204 As such, the studies have documented significant structural changes.
management of ischemic and hemorrhagic strokes in these
individuals should follow established protocols to ensure These include reductions in cortical thickness, diminished
timely evaluation and intervention. cerebral blood flow, and alterations in white matter integrity,
with notable effects observed in the frontal and limbic
8.5. Encephalopathy and Guillain–Barré syndrome regions. 213,219-221 Such changes reflect the lasting impact of
COVID-19 on brain structure and function, extending
COVID-19 has also been associated with cases of beyond the acute phase of infection (Table 6).
encephalopathy, an acute condition characterized by
altered mental status and brain dysfunction. Treatments 9.2. Long-term consequences of COVID-19 on brain
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for COVID-19-associated encephalopathy have included health
corticosteroids (e.g., methylprednisolone), intravenous Long-term follow-up studies have further elucidated the
immunoglobulin (IVIG), plasma exchange, and rituximab, enduring impact of COVID-19 on brain health. Persistent
with the goal of reducing inflammation and modulating reductions in gray matter, particularly in the left temporal
immune responses in affected patients (Table 5). 206-208
lobe, have been observed up to 2 years post-infection.
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Guillain–Barré syndrome, a rare but severe condition Resting-state functional magnetic resonance imaging
linked to COVID-19, is typically treated with IVIG or (fMRI) studies have also identified significant alterations
plasma exchange, which is the standard treatments for in brain activity in regions such as the precentral gyrus,
GBS caused by other factors. These therapies can help angular gyrus, and thalamus, indicating ongoing functional
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mitigate disease progression, particularly when respiratory disruptions (Table 6). 223-228 These findings highlight the
insufficiency appears disproportionate to pulmonary necessity for comprehensive, long-term research to fully
findings, a hallmark of GBS. elucidate the ramifications of COVID-19 on brain health.
While several promising therapeutic options are Moreover, fMRI studies have shown that individuals
under investigation to address COVID-19-associated recovering from COVID-19 frequently experience
neurological complications, their safety and efficacy cognitive deficits, neurological issues, and psychiatric
remain uncertain. Larger clinical trials are essential to symptoms. Comparative analyses of brain imaging data,
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determine whether interventions such as anti-Alzheimer’s conducted over 2 years after infection, have demonstrated
agents, cytokine antagonists, or HBOT can effectively significant differences between COVID-19 survivors and
treat COVID-19-related CI. Similarly, the management healthy controls. 224,230-232 These insights are crucial for
of strokes, encephalopathy, and GBS should continue to understanding CIs associated with long COVID, such as
follow established standards of care until more targeted brain fog, and underscore the urgent need for targeted
COVID-19 therapies become available. As research therapeutic interventions to address these persistent issues.
progresses, neuroprotective interventions may play a key
role in reducing the long-term neurological impact of 9.3. Structural and functional changes in specific
COVID-19, but a tailored approach will be crucial to brain regions
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avoid overtreatment in patients who are not at significant Neuroimaging studies of COVID-19 survivors have
risk. revealed increased amplitude of low-frequency fluctuations

Volume 4 Issue 2 (2025) 25 doi: 10.36922/an.4909