Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the
angiotensin-converting enzyme 2 (ACE2) receptor and invade the human cells to cause COVID-19-related
pneumonia. Despite an emphasis on respiratory complications, the evidence of
neurological manifestations of
SARS-CoV-2 infection is rapidly growing, which is substantially contributing to morbidity and mortality. The
neurological disorders associated with
COVID-19 may have several pathophysiological underpinnings, which are yet to be explored. Hypothetically, SARS-CoV-2 may affect the central nervous system (CNS) either by direct mechanisms like neuronal retrograde dissemination and hematogenous dissemination, or via indirect pathways. CNS complications associated with
COVID-19 include
encephalitis, acute necrotizing encephalopathy, diffuse
leukoencephalopathy,
stroke (both ischemic and hemorrhagic), venous
sinus thrombosis,
meningitis, and
neuroleptic malignant syndrome. These may result from different mechanisms, including direct
virus infection of the CNS, virus-induced hyper-inflammatory states, and post-
infection immune responses. On the other hand, the
Guillain-Barre syndrome,
hyposmia,
hypogeusia, and
myopathy are the outcomes of peripheral nervous system injury. Although the therapeutic potential of certain repurposed drugs has led to their
off-label use against
COVID-19, such as anti-retroviral drugs (
remdesivir,
favipiravir, and
lopinavir-
ritonavir combination), biologics (
tocilizumab),
antibiotics (
azithromycin),
antiparasitics (
chloroquine and
hydroxychloroquine), and
corticosteroids (
dexamethasone), unfortunately, the associated clinical neuropsychiatric adverse events remains a critical issue. Therefore,
COVID-19 represents a major threat to the field of neuropsychiatry, as both the virus and the potential
therapies may induce neurologic as well as
psychiatric disorders. Notably, potential
COVID-19 medications may also interact with the medications of pre-existing neuropsychiatric diseases, thereby further complicating the condition. From this perspective, this review will discuss the possible
neurological manifestations and sequelae of
SARS-CoV-2 infection with emphasis on the probable underlying neurotropic mechanisms. Additionally, we will highlight the concurrence of
COVID-19 treatment-associated neuropsychiatric events and possible clinically relevant drug interactions, to provide a useful framework and help researchers, especially the neurologists in understanding the neurologic facets of the ongoing pandemic to control the morbidity and mortality.