Three Stages to COVID-19 Brain Damage, New Review Suggests
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A new review outlines a three-stage classification of the impact of COVID-19 on the central nervous system and recommends hospitalized patients with the virus all undergo MRI to flag potential neurologic damage and inform postdischarge monitoring.

Authors also propose a basic “NeuroCovid” classification scheme that integrates these concepts and highlights some of the short-term challenges for the practice of neurology today and the long-term sequalae of COVID-19 such as depression, OCD, insomnia, cognitive decline, accelerated aging, Parkinson’s disease, or Alzheimer’s disease in the future.

Three-Stage Classification
NeuroCovid Stage 1:
-- The extent of SARS-CoV-2 binding to the ACE2 receptors is limited to the nasal and gustatory epithelial cells, with the cytokine storm remaining "low and controlled."
-- During this stage, patients may experience smell or taste impairments, but often recover without any interventions.

NeuroCovid Stage 2:
-- A "robust immune response" is activated by the virus, leading to inflammation in the blood vessels, increased hypercoagulability factors, and the formation of blood clots in cerebral arteries and veins.
-- The patient may therefore experience either large or small strokes.
-- Additional stage 2 symptoms include fatigue, hemiplegia, sensory loss, double vision, tetraplegia, aphasia, or ataxia.

NeuroCovid Stage 3:
-- The cytokine storm in the blood vessels is so severe that it causes an "explosive inflammatory response" and penetrates the blood–brain barrier, leading to the entry of cytokines, blood components, and viral particles into the brain parenchyma and causing neuronal cell death and encephalitis.
-- This stage can be characterized by seizures, confusion, delirium, coma, loss of consciousness, or death.

Major take-home points are that patients with COVID-19 symptoms, such as shortness of breath, headache, or dizziness, may have neurological symptoms that, at the time of hospitalization, might not be noticed or prioritized, or whose neurological symptoms may become apparent only after they leave the hospital.

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