Page 18 - CASA Bulletin of Anesthiology 2021, Vol 8, No. 6 (1)

CASA Bulletin of Anesthesiology

Fig. 2 Multi-organ complications of COVID-19 and long covid. The SARS-CoV-2 virus enters
the cells of multiple organs via the ACE2 receptor. Once these cells have been invaded, the virus
can cause a multitude of damage ultimately leading to numerous persistent symptoms.
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The long-term sequelae of COVID-19 in the central nervous system, Fig 3: (A) The long-
term immune response activates glial cells which chronically damage neurons. (B)
Hyperinflammatory and hypercoagulable states lead to an increased risk of thrombotic events.
(C) Blood-brain barrier damage and dysregulation results in pathological permeability, allowing
blood derived substances and leukocytes to infiltrate the brain parenchyma. (D) Chronic
inflammation in the brainstem may cause autonomic dysfunction. (E) The effects of long COVID
in the brain can lead to cognitive impairment. Also, a range of central, peripheral, and
psychological factors may cause chronic fatigue in long COVID. Chronic inflammation in the
brain, as well as at the neuromuscular junctions, may result in long term fatigue. In skeletal
muscle, sarcolemma damage and fiber atrophy and damage may play a role in fatigue. These
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mechanisms causing post-COVID cognitive impairment and fatigue could be linked to and
possibly cause post-COVID pain problems. Exaggerated levels of systemic inflammation,
observed in some patients as a “cytokine storm,” in addition to activation glial cells, poses a
substantial risk to the brain and central nerve system, even in peripheral nerve system and
musculoskeletal tissues to increase the likelihood of neurological manifestations.
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