The authors will present a comprehensive account of the neurological aspects of SARS-CoV-2 infection. The aim is to provide a practical clinical book which will serve as a guide for clinicians from all specialties involved in the management of COVID-19 patients. The authors share the extensive clinical experience gained in major hospitals in Lombardy, the first European region to face the COVID-19 emergency in 2020. All are recognized international experts in their respective fields and have been involved in the management of COVID-19 cases from the very beginning of the Italian SARS-CoV-2 outbreak. The text begins with a description of pathobiological and pathophysiological aspects related to the involvement of the nervous system, moving on to the discussion of the neurological complications observed in COVID-19 patients; these range from central to peripheral symptoms, and can occur in the acute or post-acute phases of the disease. Further topics are: neuropathology, seizures and EEG, neuroimaging, delirium, encephalomyelitis, stroke, psychopathology and psychiatry, neuropsychology and cognitive impairment, neuromuscu-lar disorders, and the impact of COVID-19 on other pre-existing neurological disorders. In addi-tion, the book will discuss the new developments in teleneurology approaches, which have been a direct response to the ongoing pandemic. Finally, the possible neurological complications of the COVID-19 vaccines and the neurological complications in children will be considered. Each chapter will present a critical review of the existing literature concerning the specific subject matter, followed by practical clinical recommendations, as well as personal considerations based on the experience gained by each author during the course of the COVID-19 pandemic.

"Neurology of COVID-19" will be an original and innovative reference book for clinicians of all the specialties involved in the management of patients with SARS-CoV-2 infection.

Contents

• Editors
• List of Contributors
• Preface
• Foreword
• Introduction
  • Restoring the balance
  • COVID teams
  • Hubs & Spokes
  • Personal protective equipment (PPE)
  • Teaching: students and residents
  • Work overload
  • Tele(phone)medicine
  • A lesson on empathy
  • Nurses, close to the patients
  • Neurology
• Chapter 1. SARS-CoV–2 and the nervous system: review on pathogenesis of nervous system SARS-CoV–2 damage
  Francesca Bai, Roberta Rovito, Giulia Marchetti, and Antonella d’Arminio Monforte.
  • SARS-CoV–2 and the nervous system: pathogenetic aspects
  • CNS impairment as a consequence of a direct viral effect
  • Indirect CNS damage in the course of SARS-CoV–2 infection: non-specific complications of systemic disease
  • Indirect CNS damage during SARS-CoV–2 infection: para-infectious and post-infectious immune-mediated disease
  • Brain regions affected by SARS-CoV–2 infection
  • Neuropathological findings of COVID–19 patients
  • Conclusions
  • Take-home message
  • References
• Chapter 2. The lung-brain axis
  Francesco Giuseppe Sferrazza Papa, Giulia Michela Pellegrino, and Stefano Centanni.
  • Introduction
  • Neurobiology and pathophysiology
  • Respiratory dysfunction and brainstem viral infections
  • Respiratory clinical physiology
  • Dyspnea: a complex symptom
  • Respiratory failure in COVID–19
  • Post-COVID clinical sequelae
  • Practical recommendations for the clinician
  • Take-home message
  • Acknowledgments
  • References
• Chapter 3. Does the COVID–19 related respiratory failure have a neurogenic component?
  Davide Chiumello and Matteo Bonifazi.
  • Pathological pathways
  • Clinical features and possible treatments
  • Conclusions
  • Take-home message
  • References
• Chapter 4. Neurological manifestations: an overview
  Chiara Manfredi, Emma Scelzo, Vincenzo Silani, Carlo Ferrarese, and Alberto Priori.
  • Introduction
  • Neurological manifestations of COVID–19
  • Take-home message
  • References
• Chapter 5. Neuroimaging in COVID–19
  Marco Scarabello, Carla Uggetti, and Luca Valvassori.
  • Introduction
  • Prevalence of abnormal neuroimaging findings
  • Macrovascular pathology
  • White matter abnormalities
  • Diffusion abnormalities
  • Susceptibility weighted imaging abnormalities
  • Perfusion abnormalities
  • Pathological contrast-enhancement
  • Encephalitis and encephalitis-like abnormalities
  • Practical implications in neuroimaging of COVID–19 neuropathology
  • Take-home message
  • References
• Chapter 6. Neuropathology
  Pietro Gaetano Bulfamante, Valentina Toto, Laura Carpenito, and Delfina Tosi.
  • The state of the art
  • Autopsy, biopsy, fixation and gross pathology
  • Neuronal, glial and vascular histological damages
  • Viral entry pathways into the CNS
  • Conclusions
  • Take-home message
  • References
• Chapter 7. Encephalomyelitis in COVID–19
  Alessandro Padovani, Andrea Pilotto, Alessandro Pezzini, and Alberto Benussi.
  • Introduction
  • Encephalitis and myelitis as a possible manifestation of the disease
  • Mechanisms of COVID–19-related encephalomyelitis
  • Conclusive remarks
  • Take-home message
  • References
• Chapter 8. Stroke
  Cascio Angelo Rizzo, Alessandro Innocenti, Giuditta Giussani, Francesca Lanzani, and Clemente Elio Agostoni.
  • Introduction
  • Epidemiology
  • COVID–19 and cerebral vascular disease: pathophysiological mechanisms
  • Risk factor of stroke in COVID–19 patients
  • COVID–19 and stroke characteristics
  • Stroke therapy in COVID–19 patients
  • Outcome
  • COVID–19 and hemorrhagic stroke
  • Niguarda Hospital, Milan: the COVID–19 experience
  • Stroke care and assisting patients with COVID–19 infection
  • Take-Home message
  • References
• Chapter 9. Seizures and EEG
  Valentina Chiesa, Gemma Tumminelli, and Paola Maria Canevini.
  • Introduction
  • EEG findings
  • Technical recommendations for EEG
  • Mechanisms of seizures in SARS-CoV–2
  • Seizures and SARS-CoV–2
  • Status epilepticus and SARS-CoV–2
  • Treatment suggestions
  • Conclusions
  • Take-home message
  • References
• Chapter 10. Delirium
  Chiara Manfredi, Elisabetta Bernardi, Fabrizio Luiso, Alberto Priori, and Emma Scelzo.
  • Background and epidemiology
  • Pathogenesis
  • Clinical features and implications
  • Potential factors contributing to delirium during the COVID–19 pandemic
  • Diagnostic work-up
  • Treatment strategies
  • Outcome and long-term complications
  • Take-home message
  • References
• Chapter 11. Psychiatry and psychopathology
  Bernardo Dell’Osso, Benedetta Demartini, Beatrice Benatti, Veronica Nisticò, Nicolaja Girone, and Orsola Gambini.
  • Mood disorders
  • Psychotic disorders
  • Anxiety disorders
  • Obsessive-compulsive disorder
  • Eating disorders
  • Autism spectrum disorders
  • Somatic symptom and related disorders
  • Take-home message
  • References
• Chapter 12. Cognitive dysfunction and rehabilitation
  Michelangelo Dini, Alberto Priori, and Roberta Ferrucci.
  • Introduction
  • Rationale for cognitive dysfunction in COVID–19
  • Cognitive dysfunction in COVID–19: the state of the art
  • Cognitive rehabilitation
  • Conclusions
  • Take-home message
  • References
• Chapter 13. Disorders of cranial and spinal nerves
  Tommaso Bocci*, Laura Campiglio*, and Alberto Priori.
  • Non-length dependent neuropathies: Guillain-Barré-Strohl syndrome and COVID–19
  • Length-dependent neuropathies
  • Isolated involvement of the cranial nerves
  • Practical recommendations for clinicians and personal experience
  • Take-home message
  • References
• Chapter 14. COVID–19-related myopathy
  Gianluca Costamagna, Daniele Velardo, and Pietro Giacomo Comi.
  • Introduction
  • Muscular involvement and SARS-CoV–2 infection
  • Testing
  • Treatment
  • Take-home message
  • References
• Chapter 15. Teleneurology in the COVID–19 era
  Elena Moro and Sara Meoni.
  • Introduction
  • Telestroke
  • Tele-ICU
  • Outpatient teleneurology
  • Teleneurology for long-term care facilities
  • Telerehabilitation
  • New digital technologies
  • Training and educational teleneurology
  • Practical implications and future directions
  • Take home message
  • References
• Chapter 16. Impact of COVID–19 on pre-existing neurological diseases
  Paola Alberti, Simone Beretta, Laura Brighina, Valeria Isella, and Carlo Ferrarese.
  • Introduction
  • Neuroinflammatory and neuro-oncological diseases
  • Cerebrovascular diseases
  • Epilepsy
  • Dementia and movement disorders
  • Reflections on COVID–19 vaccination in frail neurological patients
  • Take-home message
  • References
• Chapter 17. Neurological complications of vaccines for COVID–19
  Laura Bertolasi and Donata Maria Benedetti.
  • Safety definitions
  • Neurological complications of COVID–19 vaccines in clinical trials
  • Post-marketing surveillance of neurological complications of COVID–19 vaccines
  • The US
  • Europe
  • Take-home message
  • References
• Chapter 18. Neuro-COVID in children
  Ilaria Viganò, Chiara Vannicola, and Paola Maria Canevini.
  • Introduction
  • Neurological manifestations of COVID–19 in children
  • Neurological manifestations in Multisystem Inflamma-tory Syndrome in Children
  • Conclusions and clinical work-up
  • Therapeutic recommendation and prognosis
  • Take home message
  • References

This volume, and Milano University Press publications in general, unless otherwise specified, are submitted to an external refereeing process under the responsibility of the Milano University Press Editorial Board. The works published are evaluated and approved by the Editorial Board of the publishing house, and must be compliant with the Peer review policy, the Open Access, Copyright and Licensing policy and the Publication Ethics and Complaint policy as reflected in MilanoUP publishing guidelines (Linee Guida per pubblicare su MilanoUP).

With the patronage of the Società Italiana di Neurologia

The book has been partly supported by “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy.

General note on figures and tables

Unless otherwise indicated, figures and tables have been prepared by the author(s) of the chapter in question.

The Editor is committed to striving to satisfy all copyright requirements concerning graphics, images and tables for which it has not been possible to identify the type of licence used.