key: cord-0831122-h6y3py4t
authors: Oliveira, Renato; Sotero, Filipa Dourado; Teodoro, Tomás
title: NeuroCOVID: critical review of neuropsychiatric manifestations of SARS-CoV-2 infection
date: 2020-09-09
journal: Ir J Med Sci
DOI: 10.1007/s11845-020-02367-4
sha: 1ea9410919294c72d35dc1346f8d3e01a815a019
doc_id: 831122
cord_uid: h6y3py4t

nan

commonly reported neurological manifestations include nonspecific symptoms that may be consequence of the systemic inflammatory response rather than direct neurological involvement. In mild cases, the most consistent symptoms include hyposmia and dysgeusia probably related to SARS-CoV-2 pathophysiology (olfactory neuron transport) [2] . Specific neurological findings (e.g., ataxia, seizures) and serious neurological disease have also been reported [2, 5] ( Table 1) . Laboratory findings are largely nonspecific and SARS-CoV-2 is yet to be detected in cerebrospinal fluid [6] . Elevated D-dimer levels in severe cases may be associated with the increased risk of stroke although this finding could simply be a marker of inflammatory response [2] . Impact of past pandemics on mental health is well established with increased risk of anxiety and depression. The worsening of psychiatric symptoms in this setting is most likely related to chronic stress although there may be contribution of either acute infection or inflammatory response [4] . Individuals may develop stress-related anxiety and depressive disorders associated with several psychological and social factors. These include fear of negative disease outcomes and of transmitting the infection to loved ones; social stigma; unemployment; adjustment to new routines and family dynamics; and excessive workload, isolation, and discrimination in healthcare workers in contact with infected patients.

There are several limitations and biases to be taken into account when analyzing data from single case reports or limited case series: few data from ancillary studies; retrospective nature of the studies; absence of individual patient data to establish causal inferences; short follow-up duration to assess the possible development of postinfectious neurological syndromes; underdetection of neurological signs at admission, particularly in intensive care units with communication and neurological examination limited by several factors (e.g., invasive devices/equipment, constraints imposed by protective

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Table 1 Neurological symptoms and complications associated with SARS-CoV-2 infection