The Role of Noninvasive Multimodal Neuromonitoring

The pathophysiology of neurological injury related to Coronavirus disease-2019 (COVID-19) is multifactorial. Several pathophysiological pathways have been described in patients with COVID-19 infection presenting neurological complications. Microangiopathy has been shown to be an important underlying process causing small vessel cerebral infarct [1] or hemorrhagic transformations; endotheliitis, has been reported in the context of systemic inflammatory response (SIRS) which is shared among other COVID-19 related clinical presentations [2]. Direct viral cytopathic injury has been described in anatomopathological samples in patients with encephalitis. Autoimmune processes leading to peripheral or central neuritis have also been described with COVID infection [3]. Therefore, neurological injury related to COVID-19 may present with a variety of overlapping syndromes. This pathological myriad impacts in the monitoring of these patients as there is no specific surveillance that can be used for the screening of evolving neurological complications. Early detection of neurological complications is warranted to prevent and manage neurological complications. However, there is no concrete monitoring to apply to each of these scenarios, physicians need to be guided by high level clinical suspicion and an approach of diagnostic exclusion in the daily management of these patients. In this context, the role of noninvasive multimodal neuromonitoring acquires a new perspective in COVID-19. This chapter overviews the possible ways to early detect patients at risk of neurological complications, highlighting the importance of multimodal neuromonitoring systems.