In addition to severe respiratory symptoms, there are a growing number of reports showing a wide range of CNS complications in patients with COVID-19. In this article, the authors review the literature on these complications, ranging from non-specific symptoms to necrotising encephalopathies, encephalitis, myelitis, encephalomyelitis, endothelitis, and stroke. They postulate that there are several different mechanisms involved in COVID-19–associated CNS dysfunction, particularly activation of inflammatory and thrombotic pathways and, in a few patients, a direct viral effect on the endothelium and parenchyma. Lastly, critically ill patients frequently present with protracted cognitive dysfunction in the setting of septic encephalopathy likely due to multifactorial mechanisms. The authors concluded that further studies are needed to clarify the relative contribution of each of these mechanisms, but available data suggest that CNS complications in COVID-19 are relatively rare and probably not directly caused by the virus.
DOI: https://doi.org/10.1212/NXI.0000000000000923