Covid-19-Induced Dysautonomia: A Menace of Sympathetic Storm. (November 2021)

• Record Type: Journal Article
• Authors: Al-kuraishy, Hayder M.; Al-Gareeb, Ali I.; Qusti, Safaa; Alshammari, Eida M.; Gyebi, Gideon Ampoma.; Batiha, Gaber El-Saber
• Is Part Of: ASN neuro. Volume 13(2021)
• Publication Date: 2021-11
• Subjects: neurodegenerative diseases -- dysautonomia -- covid-19 -- sympathetic storm -- cytokine storm; Neurosciences -- Periodicals; Molecular neurobiology -- Periodicals; 573.8
• DOI: 10.1177/17590914211057635
• Languages: English
• ISSNs: 1759-0914

Abstract

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.