Features and management of acute and chronic neuro-Covid /Marco Cascella, Elvio De Blasio.

Includes bibliographical references.

Part I. Pathophysiology of COVID-19-associated neurotoxicity

An update on preclinical findings -- Ongoing clinical investigations -- Perspectives

Part II. Clinical manifestations of acute neurotoxicity

Clinical features -- CNS complications -- PNS complications -- Diagnosis.-Management -- Perspectives

Part III. Neurological and psychiatric sequelae in COVID-19 survivors: Clinical features

Neurological late complications -- psychological and psychiatric sequelae.-Diagnosis -- Tools -- The role of imaging -- Preventive strategies -- Social and economic impact.-Multidisciplinary management -- Perspectives

This book underlines how COVID-19 is a multisystem inflammatory disease and how its pathophysiology can predispose to an increased risk of neurological issues. Several scientific pieces of evidence showes the mechanisms underlying the neuroinvasive capacity of the SARS-CoV-2 through direct viral damage and indirect processes entering the CNS by different routes including the vasculature, the olfactory and trigeminal nerves, the cerebrospinal fluid, and the lymphatic system inducing a direct neurotoxicity. Furthermore, the pro-inflammatory cytokine storm and oxidative stress can induce microglial activation and damage to the blood-brain barrier, culminating in widespread neuroinflammatory process. This acute neurotoxicity is clinically expressed as anosmia and ageusia, headache, nausea and vomiting, but other neurologic manifestations such as acute cerebrovascular diseases, consciousness impairment due to encephalitis, and meningitis are also described. The PNS can also be affected by infectious damage and clinical manifestations including Guillain-Barr e syndrome, polyneuritis cranialis, and Miller Fisher Syndrome. A special issue concerns the neurocognitive dysfunction and altered consciousness manifested as delirium, agitation and confusion. Non-specific symptoms such as dizziness, seizures can accompany clinical pictures. Regardless of the admission diagnosis, a high percentage of patients discharged from ICUs develop disabilities affecting physical, cognitive and psychological activities. The symptoms such as asthenia, memory disturbances, depression, sleep disturbances, anxiety, and Post-traumatic stress disorder (PTSD), configure the so-called Post-intensive Care Syndrome (PICS). Multimodal management during the ICU stay and implementation of follow-up programs at patient discharge can reduce the incidence of this syndrome, improving the quality of life of surviving patients. In this complex scenario, a careful clinical approach through reliable diagnostic tools, and epidemiological studies aimed at evaluating the dimensions of the problem also in economic terms, is urgently needed. This book represents a valuable aid for all those healthcare professionals (intensivists, neurologist and psychiatrists, as well) involved in the management of these critically ill patients.

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