Welcome to the EPA 2022 Interactive Programme 

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Introduction:

The infection caused by the SARS-CoV-2 virus called COVID-19 may affect not only the respiratory system but also the central nervous system (CNS). Delirium is a frequent and serious condition in COVID-19 patients and may be caused by the direct invasion of the CNS or the induction of CNS inflammatory mediators or by indirect effects due to the systemic inflammatory status, other organ failure, prolonged mechanical ventilation time, immobilization but also social isolation.

We aim to critically review literature reporting this syndrome in patients infected by the SARS-CoV-2 virus with a particular emphasis on reported clinical, laboratorial and neuroimaging findings.

Methods:

A state-of-the-art literature review was performed using PubMed, Embase and Web of Knowledge using the following keywords: delirium, COVID-19, SARS-Cov-2, neuroimaging, laboratorial findings.

Results:

More than 50% of patients with COVID-19 may present with delirium and in about 20% of the cases this is the primary presentation of the disorder. Previous data suggests that these patients may show a higher frequency of certain symptoms such as agitation, myoclonus, abulia, and alogia. Some distinct neuroinflammatory syndromes have been identified in patients presenting with delirium associated with the virus, namely, autoimmune encephalitis, Acute Disseminated Encephalomyelitis (ADEM) and stroke showing its potential for CNS involvement.

Many of these patients present normal brain imaging, EEG and CSF findings but others have more specific laboratorial changes such as elevated creatinine kinase, elevated D-dimer levels, abnormal coagulation parameters and positive SARS-Cov-2 PCR in CSF or meningeal enhancement, ischemic stroke and perfusion changes in MRI imaging.

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According to the social brain hypothesis, the human brain includes a network designed for the processing of social information. This network includes several brain regions that elaborate social cues, interactions and contexts, i.e. prefrontal paracingulate and parietal cortices, amygdala, temporal lobes and the posterior superior temporal sulcus. We will explore neuroimaging studies that investigated social isolation in healthy subjects.

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Recently, many reports have been available related to neuropsychiatric complications in the course of COVID-19 infection, and its long-term consequences. Many of them are related to psychological factors, such as: isolation, change of existing habits, fear of getting sick and dying, fear of losing a job and fears related to the financial situation, which resulted in an increase in the occurrence of diseases and mental disorders such as adaptation and anxiety disorders, depression. t has been also reported that treatment in conditions of intensive care unit lead to high prevalence of psychiatric disorders like PTSD in discharged patients. In our own studies we observed that patients with new appearing psychiatric symptoms were mostly those, who were professionally active, but did not work remotely. The time the patients spent at home had a negative impact on their well-being, they generally felt worse, their family life suffered more frequently. The most common cognitive symptoms, which are reported embrace: problems with short- and long-term memory, lack of mental clarity, feeling eclipsed, lightheaded, poor concentration, mental fatigue. We also present here a series of post-acute COVID cases from the examined population and provide a concise comparison of observed symptomatology with previous reports.