Neurological and neuromuscular manifestations in SARS-CoV-2: Review of Literature and Case Series

Author(s): Robin Warner DO

Introduction: The 2019 coronavirus, known as SARS-CoV-2 and COVID-19, was named a pandemic by the WHO in March 2020. It binds to the ACE-2 receptor and transmembrane serine protease 2 and is highly virulent. There are many sequelae of this virus, including neurological consequences. We have performed a literature review of the neurological sequelae of COVID-19 with relation to neuroimaging and then present a case series. Case Series: Seven cases were seen by neurology consultants at the Hospital for Special Surgery in New York City between February and May of 2020; 5 met criteria. Most of these consultations were called for encephalopathy. Some had neuroimaging of brain MRI or head CT, which all showed microvascular disease. One case had prior imaging without microvascular disease. Summary: It is known that vascular disease is a risk factor for severe COVID-19 infection. This case series demonstrates presence of microvascular disease in patients with encephalopathy. We know that microvascular disease can be a risk factor for toxic metabolic encephalopathy. It is unclear if the microvascular disease was present prior to infection, although at least one patient had prior imaging without microvascular disease. More research is needed to determine if COVID-19 infection can cause vascular disease.