Study by UF neurointensivists details potential neurologic complications of severe respiratory viruses

A new study by University of Florida Health neurocritical care experts offers insight into potential neurologic complications of severe respiratory viruses, including COVID-19, and could help guide diagnosis and treatment for neurologists on the frontlines of the pandemic.

The review, published Friday in the journal Critical Care Explorations, describes neurologic complications such as seizures and encephalitis that have been associated with past coronaviruses such as SARS and MERS in some patients.

Katharina M. Busl, M.D., an associate professor and division chief of neurocritical care at UF Health and medical director of the UF Health Shands Hospital Neuro Intensive Care Unit, and Christopher P. Robinson, D.O., a clinical assistant professor in the department of neurology in UF’s College of Medicine, write that while evidence is being collected clarifying whether neurological manifestations are directly due to COVID-19 or are a neurological response to infection, other types of severe respiratory viruses have led to serious and sometimes irreversible neurologic complications in some cases.

Robinson further explains how the study of severe respiratory viruses as a whole may help guide neurologists during this pandemic:

Why do severe respiratory viruses sometimes cause neurologic complications?

This is due to a phenomenon called neurotropism, meaning the ability of the virus to invade the brain. It is well-documented that the cells in the respiratory tract that are attacked by the virus also exist in the brain and brainstem. Certain viruses, including coronaviruses, have the ability to attach to nerve endings in the nose and mouth and travel toward the brain, causing infection.

What are some of the documented neurologic manifestations of severe respiratory viruses, and how are neurologic manifestations different in coronaviruses such as SARS and MERS compared with the flu?

Common problems include seizures, confusion and encephalitis. Other conditions that may arise following infection include inflammation of the brain and extremity weakness from nerve damage. Neurologic disease from coronaviruses differs from the flu in that coronaviruses have the ability to directly invade the brain, causing a myriad of neurologic symptoms.

How are neurologic complications of severe respiratory viruses typically treated?

At present, most complications are treated symptomatically, and no magic bullet for intervention exists. However, early recognition allowing for treatment is important and can improve outcomes.

Why is it important to compare COVID-19 with severe acute respiratory syndrome coronavirus, or SARS, and Middle Eastern respiratory syndrome, or MERS?

COVID-19 is the clinical syndrome associated with the novel SARS coronavirus 2, or SARS CoV2, infection. Evidence suggests this virus stemmed from an animal source, and both SARS and MERS are also coronaviruses from animal sources. It is important to review the data of neurologic problems associated with these past epidemics to gain a glimpse at the potential implications of the current pandemic.