Cerebral and spinal neurological complications in patients with COVID-19: authors’ clinical experience and literature review

  • A.V. Paenok Lviv National Medical University named after Danylo Halytsky, Lviv, Ukraine
  • A.M. Netliukh CNPE «Lviv Clinical Emergency Hospital», Ukraine https://orcid.org/0000-0002-6499-1718
  • O.Ya. Kobyletskyi Lviv National Medical University named after Danylo Halytsky, Lviv, Ukraine
  • N.V. Matolinets CNPE «Lviv Clinical Emergency Hospital», Ukraine
  • R.-M. M. Yunko CNPE «Lviv Clinical Emergency Hospital», Ukraine
  • V.I. Kuts-Karpenko CNPE «Lviv Clinical Emergency Hospital», Ukraine
  • O.-N.А. Bakun Lviv National Medical University named after Danylo Halytsky, Lviv, Ukraine
Keywords: COVID-19; lesions of the nervous system; ischemic stroke.


Objective ‒ to highlight the high probability and features of neurological complications in patients with COVID-19 pneumonia.
Materials and methods. A retrospective cohort study was done of 57 patients with COVID-19 pneumonia who were treated at the COVID-location of the Department of Vascular and Minimally Invasive Neurosurgery and Neurology of the Clinical Emergency Hospital of Lviv in the period from June 29 to September 28, 2020 (91 day).
Results. Out of the 57 patients 14 (24.6 %) were selected by prospective analysis that had a clear association between COVID-19 pneumonia and neurological complications. Neurological complications of COVID-19 were manifested as ischemic stroke in 57.1 % of patients, encephalopathy with convulsions and without seizures ‒ in 35.7 %, polyneuropathy with tetraparesis, secondary purulent-inflammatory lesions of the spine ‒ in 7.2 %. Neurological complications occurred on average (20. 4 ± 6.1) days after the onset of the disease.
Conclusions. Lesions of the spine and structures in the spinal canal after coronavirus infection had a significant spread along the axis of the spine and severe course. The largest (57.1 %) was the proportion of ischemic stroke in the structure of neurological complications of COVID-19, which indicated the severity of the coronavirus infection and its aggressive effect on the nervous system. The effectiveness of treatment of COVID-19 neurological complications depends on the urgency of hospitalization of patients, as evidenced by the correlation between favorable treatment outcomes and the time from disease onst to admission to either therapeutic (r = + 0.37) or neurological department (r = +0.32).


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Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci. 2020;41(7):1667-71. doi: 10.1007/s10072-020-04486-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262683/

Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Zhengyuan Xia. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19) Journal of General Internal Medicine. 2020;35:1545-9. https://doi.org/10.1007/s11606-020-05762-w

Karimi N, Sharifi Razavi A. Rouhani N. Frequent convulsive seizures in an adult patient with COVID-19: a case report. Iran Red Crescent Med J. 2020;3(22):20200301. https://doi.org/10. 5812/ircmj.102828

Yasri S, Wiwanikit V. COVID-19 and epilepsy. Ann Indian Acad Neurol. 2020;23(7):43. https://doi.org/10.4103/aian.AIAN_254_20

Lu L, Xiong W, Liu D, et al. New-onset acute symptomatic seizure and risk factors in corona virus disease 2019: a retrospective multicenter study. Epilepsia. 2020;61(6):e49-e53. https://doi.org/10.1111/epi.16524

Nicastri E, Petrosillo N, Bartoli TA, et al. National Institute for the Infectious Diseases “L. Spallanzani”, IRCCS. Recommendations for COVID-19 clinical management. Infectious Disease Reports. 2020;12(1). https://doi.org/10.4081/idr.2020.8543

Badyal DK, Mahajan RJIJA. Chloroquine: Can it be a Novel Drug for COVID-19. Int J Appl Basic Med Res. 2020; 10(2):128-30. https://doi.org/10.4103/ijabmr.IJABMR_141_20

Libbey JE, Fujinami RSJF (2011) Neurotropic viral infections leading to epilepsy: focus on Theiler’s murine encephalomyelitis virus. Future virology. 2011;6(11):1339-50. https://doi.org/10.2217/fvl.11.107

Pratibha Singhi Infectious causes of seizures and epilepsy in the developing world. Dev Med Child Neurol. 2011;53(7):600-9. https://doi.org/ 10.1111/j.1469-8749.2011.03928.x

Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-coronavirus-2. International Journal of Infectious Diseases. 2020;94:55-8. https://doi.org/10.1016/j.ijid.2020.03.062

Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020 Jul;87:18-22. https://doi.org/10.1016/j.bbi.2020.03.031

Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (covid-19): encephalopathy. Cureus. 2020 12(3):e7352. https://doi.org/10.7759/cureus.7352

Ying W, Qian Y, Kun Z. Drugs supply and pharmaceutical care management practices at a designated hospital during the COVID-19 epidemic. Research in Social and Administrative Pharmacy. 2021;17(1):1978-83. https://doi.org/10.1016/j.sapharm. 2020.04.001

Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral haemorrhage: causative or coincidental? New Microbes New Infect. 2020;35:100669. https://doi.org/10.1016/j.nmni. 2020.100669

Liu Z, Xiao X, Wei X, et al. Composition and divergence of coronavirus spike proteins and host ACE2 receptors predict potential intermediate hosts of SARS-CoV-2. J Med Virol. 2020;92(6):595-601. https://doi.org/10.1002/jmv.25726

Steardo L, Steardo L Jr, Zorec R, Verkhratsky A. Neuroinfection may potentially contribute to pathophysiology and clinical manifestations of COVID-19. Acta Physiol (Oxf). 2020;229(3):e13473. https://doi.org/10.1111/apha.13473

Padda I, Khehr N, Jaferi U, Parmar MS. The neurological complexities and prognosis of COVID-19. SN Compr Clin Med. 2020:1-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522181/

Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: a literature review. J Clin Neurosci. 2020;77:8-12. https://doi.org/10.1016/j.jocn.2020.05.017 [Accessed June 27, 2020 https://www.jocn-journal.com/article/S0967-5868(20)31078-X/pdf].

Fan H, Tang X, Song Y, Liu P, Chen Y. Influence of COVID-19 on cerebrovascular disease and its possible mechanism. Neuropsychiatr Dis Treat. 2020;16:1359-67. https://doi.org/10.2147/NDT.S251173 [Accessed June 27,2020 https://www.dovepress.com/influence-of-covid-19-on-cerebrovascular-disease-and-its-possible mech-peer-reviewedarticle-NDT].

Wang L, Shen Y, Li M, et al. Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARSCoV-2: a systematic review and meta-analysis. J Neurol. 2020:1-13. https://doi.org/10.1007/s00415-020-09974-2 [Accessed July 8th, 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288253/].

Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol. 2020:1-19. https://doi.org/10.1007/s00415-020-09990-2 [published online ahead of print, 2020 Jun 19] [Accessed July 9th, 2020 https://www.ncbi.nlm.nih. gov/pmc/articles/PMC7304377/].

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. https://doi.org/10.1001/jama.2020.1585 [Acessed June 28,2020,https://jamanetwork.com/journals/jama/fullarticle/2761044].

Reddy ST, Garg T, Shah C, et al. Cerebrovascular disease in patients with COVID-19: a review of the literature and case series. Case Rep Neurol. 2020;12(2):199-209. https://doi.org/10.1159/000508958 [Accessed July 10, 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325208/].

Wang J, Hajizadeh N, Moore EE, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): a case series. J Thromb Haemost. 2020;18(7):1752-5. https://doi.org/10.1111/jth.14828

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-9. https://doi.org/10.1111/jth.14817 [Accessed June 28, 2020, https://onlinelibrary.wiley.com/doi/full/10.1111/ jth.14817].

Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92(6):552-5. https://doi.org/10.1002/jmv.25728 [Accessed July 8, 2020 https://www.ncbi.nlm. nih.gov/pmc/articles/PMC7228394/].

Jasti M, Nalleballe K, Dandu V, Onteddu S. A review of pathophysiology and neuropsychiatric manifestations of COVID-19. J Neurol. 2020:1-6. https://doi.org/10.1007/s00415-020-09950-w [Accessed July 8, 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268182/].

Cheng H, Wang Y, Wang GQ. Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19. J Med Virol. 2020;92(7):726-30. https://doi.org/10.1002/jmv.25785 [Accessed July 9th, 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317908/].

Yashavantha Rao HC, Jayabaskaran C. The emergence of a novel coronavirus (SARS-CoV-2) disease and their neuroinvasive propensity may affect in COVID-19 patients. J Med Virol. 2020;92(7):786-90. https://doi.org/10.1002/jmv.25918 [Accessed Jun 16th, 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264535/].

Yarikov AV, Fraerman AP, Perlmutter OA, y dr. Nespecificheskie gnojno-vospalitelnye porazheniya pozvonochnika: spondilodiscit, epidurit. Zhurnal imeni N.V. Sklifosovskogo Neotlozhnaya medicinskaya pomosh. 2019;8(2):175-85. https://doi.org/10.23934/2223-9022-2019-8-2-175-185 (In Russian)

Samchuk OO, Matolinets NV. Cardiopulmonary resuscitation and intensive care in patients with coronavirus disease (clinical cases). Praci NTSh. Medichni nauki. 2020;59 (1):160-80. DOI: 10.25040/ntsh2020.01.16 (In Ukrainian)

Bohdan I, Plakhtyrʹ Z, Bohdan A. Rolʹ promenevoyi diahnostyky u rannʹomu vyyavlenni ta kontrolyu perebihu hniynoho osteomiyelitu khrebta. Proc Shevchenko Sci Soc Med Sci [internet]. 07, Kvitenʹ 2021 [tsyt. za 09, Serpen' 2021];64(1). dostupnyy u: https://mspsss.org.ua/index.php/journal/article/view/402. DOI: https://doi.org/10.25040/ntsh2021.01.12

Herrero CFPS, Nascimento AL, Cunha RP, Souza GPV. Infectious spondylodiscitis: has there been any evolution in the diagnostic and treatment outcomes. Coluna /Columna. 2014;13(4):294-7. DOI: 10.1590/S1808-18512014130400442.

Mei PA, Loeb L. COVID-19: a chronological review of the neurological repercussions ‒ what do we know by May, 2020? medRxiv. 2020. https://doi.org/10.1101/2020.05.19.20107102 [Accessed 30 June 2020. 10.1101/2020.05.19.20107102.].

Bridwell R, Long B, Gottlieb M. Neurologic complications of COVID-19. Am J Emerg Med. 2020;38(7):1549.e3-7. https://doi.org/10.1016/j.ajem.2020.05.024 [Accessed 30 June 2020, https://www.ajemjournal.com/article/S0735-6757(20)30364-8/pdf].

Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: cli-nical, radiological and laboratory findings. Brain. 2020;143(10):3104-20. https://doi.org/10.1093/brain/awaa240 [Accessed July 12, 2020 https://pubmed.ncbi.nlm.nih.gov/32637987/].

Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):1-9. https:// doi.org/10.1001/jamaneurol.2020.1127 [Accessed June 27, 2020, https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549].

How to Cite
Paenok, A., Netliukh, A., Kobyletskyi, O., Matolinets, N., Yunko, R.-M. M., Kuts-Karpenko, V., & Bakun, O.-N. (2021). Cerebral and spinal neurological complications in patients with COVID-19: authors’ clinical experience and literature review. Ukrainian Interventional Neuroradiology and Surgery, 36(2), 50-59. https://doi.org/10.26683/2786-4855-2021-2(36)-50-59