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Neurology and COVID-19

Educational Objective
To understand how COVID-19 is affecting the field of neurology
1 Credit CME

In the early days of the coronavirus disease 2019 (COVID-19) pandemic, involvement by neurologists seemed unnecessary. The virus was thought to lead to a respiratory illness, largely sparing the brain and the rest of the nervous system. However, early reports from large outbreaks in China quickly changed this view. A study of more than 200 patients hospitalized in 3 COVID-19–focused hospitals in Wuhan demonstrated that more than one-third experienced a variety of neurologic manifestations, including altered mental status and acute cerebrovascular diseases, most commonly in those with severe respiratory illness.1 These findings quickly changed the perspective of neurologists worldwide and focused efforts toward both understanding the mechanisms responsible for this neurologic involvement and devising systems of care to identify and effectively treat these increasingly recognized complications.

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Article Information

Corresponding Author: S. Andrew Josephson, MD, UCSF Department of Neurology, 505 Parnassus Ave, Box 0114, San Francisco, CA 94143 (andrew.josephson@ucsf.edu).

Conflict of Interest Disclosures: Dr Josephson reported serving as associate editor for Continuum Audio. Dr Kamel reported serving as co–principal investigator for the National Institutes of Health–funded ARCADIA trial (NINDS U01NS095869), which receives in-kind study drug from the BMS-Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics, serving as a steering committee member for Medtronic’s Stroke AF trial (uncompensated), serving on an end-point adjudication committee for a trial of empagliflozin for Boehringer Ingelheim, and having served on an advisory board for Roivant Sciences related to factor XI inhibition.

References
1.
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):683-690. doi:10.1001/jamaneurol.2020.1127PubMedGoogle ScholarCrossref
2.
Merkler  AE , Parikh  NS , Mir  S ,  et al.  Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza.   JAMA Neurol. Published online July 2, 2020. doi:10.1001/jamaneurol.2020.2730PubMedGoogle Scholar
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Kansagra  AP , Goyal  MS , Hamilton  S , Albers  GW .  Collateral effect of Covid-19 on stroke evaluation in the United States.   N Engl J Med. 2020;383(4):400-401. doi:10.1056/NEJMc2014816PubMedGoogle ScholarCrossref
4.
Solomon  IH , Normandin  E , Bhattacharyya  S ,  et al.  Neuropathological features of Covid-19.   N Engl J Med. Published online June 12, 2020. doi:10.1056/NEJMc2019373PubMedGoogle Scholar
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Politi  LS , Salsano  E , Grimaldi  M .  Magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia.   JAMA Neurol. 2020;77(8):1028-1029. doi:10.1001/jamaneurol.2020.2125PubMedGoogle ScholarCrossref
6.
Zubair  AS , McAlpine  LS , Gardin  T , Farhadian  S , Kuruvilla  DE , Spudich  S .  Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review.   JAMA Neurol. 2020;77(8):1018-1027. doi:10.1001/jamaneurol.2020.2065PubMedGoogle ScholarCrossref
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Louapre  C , Collongues  N , Stankoff  B ,  et al; Covisep Investigators.  Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis.   JAMA Neurol. Published online June 26, 2020. doi:10.1001/jamaneurol.2020.2581PubMedGoogle Scholar
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