Title : Possible neurological and psychiatric risks from COVID-19 during post-COVID period
Abstract:
Coronavirus disease 2019 (COVID-19) is a multi-organ and multi-system disease, associated with high morbidity and mortality due to pulmonary and cardiovascular involvement, and attended by various neurological and psychiatric (N and P) manifestations during its acute and subsequent phases. Additionally, there is a long term impact to health. There are certain factors which carry propensity to higher risks for neurological and psychiatric disorders in COVID-19 and post-COVID patients. In general, the severity of COVID-19 had a definite effect on subsequent N and P diagnoses. Etiopathology of neurological involvement in COVID-19 patients is diverse and multifactorial. There is clear evidence that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly invade CNS to a substantial extent, and the dysfunctional, erratic, and overactive immune system triggered by SARS-CoV-2 appears in neurological involvement. In severe COVID-19, systemic hypoxia occurring due to pneumonia may lead to direct damage to brain and nerve cells. The dysfunctional activity of renin-angiotensin system is another relevant mechanism affecting the disease course variously. There occur wide ranging both short-term and long-term neurological manifestations and consequences during COVID-19 and post-COVID period. There are difficulties related to memory, attention, and focus, referred to as “brain fog”, persistent headaches, lingering loss of sense of smell and taste, and enduring muscle aches, accompanied by chronic fatigue. Encephalopathy, characterized by altered cerebral function ranging from mild confusion to coma, is a serious neurological manifestation associated with adverse outcomes in COVID-19. There are associated prolonged prothrombin time, platelet abnormalities, elevated levels of D-dimer, increased fibrinogen/fibrin degradation products, and sepsis-induced coagulopathy. Further, COVID-19 patients with pneumonia and ARDS suffer with hypoxia, that increases risk of thrombosis by increasing blood viscosity. In addition, the systemic inflammation activates pro-coagulation mechanisms by thrombin generation and inhibiting endogenous fibrinolysis, leading to a high risk of thrombotic and cerebrovascular events. The N and P manifestations in COVID-19 are variable and can emerge early or during the clinical course, or later as long-term complications. The lab investigations and neuro-imaging findings are helpful in quantifying the risk, disease course, and prognosis. In general, the N and P manifestations are dealt with in accordance with symptomatic and standard therapy practices. It should be confessed that presently our understanding about long-term N and P effects of COVID-19 and medical, psychological and rehabilitation needs of these patients is limited.
