Open AccessCovid-19-Induced Dysautonomia: A Menace of Sympathetic Storm
Author(s) -
Hayder M Al-Kuraishy,
Ali I. AlGareeb,
Safaa Qusti,
Eida M. Alshammari,
Gideon Ampoma Gyebi,
Gaber ElSaber Batiha
Publication year - 2021
Publication title -
asn neuro
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.039
H-Index - 45
ISSN - 1759-0914
DOI - 10.1177/17590914211057635
Subject(s) - cytokine storm , sympathetic nervous system , rostral ventrolateral medulla , medicine , autonomic nervous system , dysautonomia , immunology , neuroscience , central nervous system , biology , covid-19 , medulla oblongata , blood pressure , heart rate , infectious disease (medical specialty) , disease
Among the plethora of debilitating neurological disorders of COVID-19 syndrome in survivors, the scope of SARS-CoV-2-induced dysautonomia (DNS) is yet to be understood, though the implications are enormous. Herein, we present an inclusive mini-review of SARS-CoV-2-induced DNS and its associated complications. Although, the direct link between Covid-19 and DSN is still speculative, the hypothetical links are thought to be either a direct neuronal injury of the autonomic pathway or a para/post-infectious immune-induced mechanism. SARS-CoV-2 infection-induced stress may activate the sympathetic nervous system (SNS) leading to neuro-hormonal stimulation and activation of pro-inflammatory cytokines with further development of sympathetic storm. Sympathetic over-activation in Covid-19 is correlated with increase in capillary pulmonary leakage, alveolar damage, and development of acute respiratory distress syndrome. Furthermore, SARS-CoV-2 can spread through pulmonary mechanoreceptors and chemoreceptors to medullary respiratory center in a retrograde manner resulting in sudden respiratory failure. Taken together, DSN in Covid-19 is developed due to sympathetic storm and inhibition of Parasympathetic nervous system-mediated anti-inflammatory effect with development of cytokine storm. Therefore, sympathetic and cytokine storms together with activation of Renin-Angiotensin-System are the chief final pathway involved in the development of DSN in Covid-19.