Neurological Complications of COVID-19

Koronavirusna bolest u 2019. godini (COVID-19) uzrokovana je novootkrivenim korona virusom tipa 2 koji uzrokuje teški akutni respiratorni sindrom (SARS-CoV-2). Virus je otkriven u prosincu 2019. godine, a od strane Svjetske zdravstvene organizacije je, zbog broja oboljelih i proširenosti širom svijeta, proglašena pandemija. Klinička prezentacija COVID-19 varira od asimptomatskog do teškog oblika i smrtnog ishoda. Iako kliničkom slikom dominiraju respiratorne smetnje, mnogobrojne studije ukazuju na pojavu akutnih i kroničnih neuroloških komplikacija u skoro trećine oboljelih. Najčešći neurološki simptomi akutne faze COVID-19 su glavobolja, gubitak njuha i okusa, poremećaji stanja svijesti, encefalopatije, encefalitisi, moždani udar, bolovi u mišićima, epileptički napadaji, poliradikulopatije (GBS) te pojačan umor i netolerancija napora, poremećaji vegetativnih funkcija, kognitivne i psihičke smetnje u postinfekcijskoj fazi oboljenja. Potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja u akutnoj fazi uključuje koagulopatije s udruženim hipoksično-ishemijskim oštećenjima, poremećajem krvno-moždane barijere, endoteliopatijama i neuroinvazijom virusa, udruženom s neuro-imunim odgovorom. Cilj ovog članka je prikazati najčešće akutne i kronične neurološke poremećaje vezane uz COVID-19 kod odraslih bolesnika kao i potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja, a buduće epidemiološke studije o bolesnicima s COVID-19 bi trebali utvrditi pravu incidenciju neuroloških komplikacija COVID-19, razgraničiti specifične neurološke sindrome, postaviti dijagnostičke i terapijske protokole ta razjasniti mehanizam nastanka poremećaja.Coronavirus disease in 2019 (COVID-19) is caused by the newly discovered coronavirus type 2 which causes severe acute respiratory syndrome (SARS-CoV-2). The virus was discovered in December 2019, and the World Health Organization has declared a pandemic due to the number of cases and the spread around the world. The clinical presentation of COVID-19 varies from asymptomatic to severe and lethal outcome. Although the clinical picture is dominated by respiratory disorders, numerous studies indicate the occurrence of acute and chronic neurological complications in almost a third of patients. The most common neurological symptoms of the acute phase of COVID-19 are headache, loss of smell and taste, disturbances of consciousness, encephalopathies, encephalitis, stroke, muscle pain, epileptic seizures, polyradiculopathy (GBS) and increased fatigue and intolerance to stressful and mental disorders in the postinfectious phase of the disease. Potential pathophysiological mechanisms of the development of neurological disorders in the acute phase include coagulopathies with associated hypoxic-ischemic damage, blood-brain barrier disorder, endotheliopathies and neuroinvasion of viruses with associated neuro-immune response. The objective of this paper is to present the most common acute and chronic neurological disorders related to COVID-19 in adult patients as well as the potential pathophysiological mechanism of neurological disorders, and future epidemiological studies on patients with COVID-19 should determine the true incidence of specific neurological syndromes, to establish diagnostic and therapeutic protocols and to clarify the mechanism of disorder development