Trigeminalna neuralgija

Trigeminal neuralgia is one of the most common causes of facial pain. It implies short lasting episodes of unilateral electric shock-like pain with abrupt onset and termination, in the distribution of one or more divisions of the trigeminal nerve that are triggered by innocuous stimuli. Most cases of trigeminal neuralgia are caused by compression of the trigeminal nerve root. Depending on the etiology, trigeminal neuralgia can be classified as classic trigeminal neuralgia or painful trigeminal neuropathy. It may be precipitated by some actions at trigger zones. The diagnosis of trigeminal neuralgia is based on diagnostic criteria for classic trigeminal neuralgia, neuroimaging and electrophysiologic trigeminal reflex testing. Treatment of classic trigeminal neuralgia for most patients is pharmacological therapy, while surgical approach is reserved for patients that are refractory to medical therapy and in cases of painful trigeminal neuropathy.Trigeminalna neuralgija jedan je od najčešćih uzroka boli u području lica. Definicija trigeminalne neuralgije podrazumijeva kratkotrajne epizode jednostrane boli nalik elektroškovima s iznenadnim početkom i završetkom u distribuciji jedne ili više grana trigeminalnog živca, a potaknute bezopasnim poticajem. U većini slučajeva trigeminalna neuralgija uzrokovana je pritiskom na korijen trigeminalnog živca. Ovisno o etiologiji, trigeminalna se neuralgija klasificira kao klasična trigeminalna neuralgija odnosno kao bolna trigeminalna neuropatija. Moguće ju je izazvati određenim aktivnostima u području zona okidanja. Dijagnoza trigeminalne neuralgije postavlja se na osnovi dijagnostičkih kriterija, slikovnih prikaza struktura središ-njega živčanog sustava te elektrofizioloških testiranja trigeminalnih refleksa. Liječenje klasične trigeminalne neuralgije za većinu bolesnika je farmakološke naravi, dok je operativni pristup rezerviran za bolesnike refraktorne na medikamentnu terapiju te bolesnike s bolnom trigeminalnom neuropatijom

COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE TREATMENT OF MULTIPLE SCLEROSIS

Multipla skleroza je kronična, za sada, neizlječiva bolest. Pet osnovnih smjerova čini lepezu u liječenju bolesnika s MSom: modifi ciranje tijeka bolesti, liječenje relapsa, liječenje simptoma bolesti, produživanje funkcijske sposobnosti putem fi zikalne terapije te pružanje emocionalne podrške. S obzirom na trajanje bolesti i na smetnje s kojima se bolesnici susreću, istraživanja su pokazala da mnogi oboljeli od multiple skleroze primjenjuju barem neku od tehnika komplementarne i alternativne medicine (KAM) radi liječenja bolesti, a taj se udio kreće od 30 do 80 %. Dio bolesnika primjećuje korist od primijenjene terapije, no suvremena medicinska zajednica ima, za sada, samo ograničene spoznaje o sigurnosti primjene pojedinih postupaka odnosno o njihovoj učinkovitosti koja je u prvom redu usmjerena na protuupalni učinak i neuroprotekciju. Zdravstveni su profesionalci pritom važan i pouzdan izvor podataka za bolesnike o komplementarnoj i alternativnoj medicini, posebno zato što mnogi bolesnici ne spominju uporabu tehnika komplementarne i alternativne medicine tijekom redovitih pregleda kod neurologa. Neki bolenici su nedovoljno kritični ili upoznati sa svim mogućim djelovanjima pojedinih tvari. Stoga je važno da liječnik bude informiran o svemu što bolenik poduzima za svoje zdravlje, jer se samo tako mogu procijeniti moguće posljedice primjene terapije KAM, povoljne ili nepovoljne, odnosno moguće interakcije s konvencionalnim načinima liječenja.Introduction: Multiple sclerosis (MS) is a chronic, yet incurable disease. Currently, there are fi ve different approaches in patient management: disease modifying therapy, relapse treatment, symptomatic treatment, and extension of better functional ability through implication of physical therapy and emotional support. Considering the long-term lifelong duration of the disease and concomitant symptoms, many patients (30%-80%) use at least one of complementary and alternative (CAM) techniques for either primary or additional treatment of this disease. Aim: Our aim was to search through scientifi cally published papers for medically valid data in order to provide the best medical advice for both physicians and patients in search for useful and non-harmful CAM methods. Methods: We performed extensive MEDLINE search and included references dating back from the year 2000, since we believed the most recent data to carry the most relevant and updated information. Results and Discussion: We noticed that patients were prone to using CAM methods, either solely or in addition to prescribed therapy by their conventional medical doctor, usually a neurologist. The rate was higher for women, those with higher educational level, and those whose health was not rated well. CAM therapies can be divided into biologically based practices (cannabinoids, gingko biloba), other biologically based practices such as bee venom, dietary supplementation (omega-3 fatty acids, Cari Loder regimen), energy medicine and manipulative body-based practices (magnetic therapy and reflexology). Some benefi ts are reported as subjective and others as objective improvement, but patients tend to be either over- or under-critical in therapy assessment. Thus, true scientifi cally supported data are necessary for evaluation, best collected by the primary care giving neurologist, or by the patients themselves. All these data need to be handed to a medical specialist, i.e. MS nurse or neurologist in charge, who will thus be informed on the treatment effects and potential adverse effects. Therefore, in this article, we propose data collection tabulated diaries for easier monitoring. We, also, present scientifi c evidence based data that support the benefi cial effect of CAM therapies for the patient. Additionally, severe adverse effects of these therapies are also mentioned. Most importantly, the level of interaction with disease modifying therapy is still unknown, so it is best to advise your patients about the possible interactions and to monitor for any changes in physical or mental status. Conclusion: The goal would be to collect as much data as possible and re-evaluate all relevant three points in patient management, i.e. effectiveness of CAM therapy, noted adverse effects, and possible infl uence on disease modifying agents. The best approach to patient management is through MS centers that are comprehensively equipped for both diagnostic and therapeutic approach. This team approach would improve the patient sense of security in the system of care, and increase the functionality of diagnosis and treatment and patient independence. The neurologist should be in charge of this team and coordinate it, since his knowledge of the disease process and pathophysiology allows for identifi cation of important issues that can further determine or alter the course of treatment

Effects of Trigeminal Nerve Dysfunction in Various Types of Headaches

Headaches are one of the most common ailments in modern society, leading to severe diminishing of general activities and they result in significant impact on the patient\u27s quality of life. Blink reflex is an objective neurophysiological method for determining the status of the trigeminal system, facial nerve and the lateral part of medulla oblongata. The aim of this study was to examine the connection between trigeminal nerve dysfunction and various types of headaches using functional electrophysiological assessment of blink reflex tests in patients and controls. The sample comprised 60 subjects with headache attacks, 44 females, and 16 males). The control group consisted of 30 healthy subjects (19 females, and 11 males) who did not suffer from headaches. The age of subjects ranged from 20 years to 76 years with the mean of 42.81 years. Trigeminal nerve function was assessed by using blink reflex tests in patients suffering from headaches and in controls, applying the standard procedure described by Kimura et al. Pathological findings of blink reflex were observed in 58.3 % of patients suffering from headaches and in only 20 % of cases in the control group. The application of Yates’ χ2 test showed a significant correlation between pathological blink reflex and headache occurrence (χ2 = 10.354; P = 0.001). Normal blink reflex was found in 41.7 % of patients suffering from headaches and in 80 % of control group subjects. Females with pathological blink reflex have 4 times higher risk for headaches than controls (OR = 4.107; 95% CI = 1.036 - 17.565). Males with pathological blink reflex have a considerably higher risk for headaches, and it was 13 times higher than in controls (OR = 13.500; 95% CI = 1.555 - 153.646). There is a strong correlation between pathological blink reflex and the occurrence of headaches in both genders, indicating significant association of trigeminal nerve dysfunction with the occurrence of headaches. The use of blink reflex testing could be of help to detect patients with an increased risk for headaches

Uloga komplementarne i alternativne medicine u terapiji multiple skleroze

The National Center for Complementary and Alternative Medicine defines complementary and alternative medicine as a group of diverse medical and health care systems, practices and products that are not generally considered part of conventional medicine. Multiple sclerosis (MS) is a chronic disabling disease of the central nervous system that affects people during early adulthood. In spite of many approved medications, the treatment options in MS are limited. Many people with MS explore complementary and alternative medicine (CAM) treatments to help control their MS and treat their symptoms. Surveys suggest that up to 70% of people with MS have tried one or more CAM treatment for their MS. People with MS using CAM generally report deriving some benefit from therapies. The CAM therapies most frequently used include diet, omega-3 fatty acids and antioxidants. The therapies with highest potential among CAM therapies that warrant further investigation are low-fat diet, omega-3 fatty acids, lipoic acid, and vitamin D supplementation as potential anti-inflammatory and neuroprotective agents in both relapsing and progressive forms of MS. There are very limited researches evaluating the safety and efficacy of CAM in MS. However, in recent years, the USA National Institutes of Health and the National Multiple Sclerosis Society have been actively supporting the researches in this very important area.Nacionalni centar za komplementarnu i alternativnu medicinu u Sjedinjenim Američkim Državama definira komplementarnu i alternativnu medicinu kao skupinu različitih medicinskih i zdravstvenih sustava, praksa i proizvoda koji se općenito ne smatraju dijelom konvencionalne medicine. Multipla skleroza je kronična onemogućavajuća bolest središnjeg živčanog sustava koja se javlja u mlađoj odrasloj dobi. Unatoč mnogim istraženim i odobrenim lijekovima mogućnosti liječenja multiple skleroze su ipak ograničene. Zbog toga mnogi bolesnici koji boluju od multiple skleroze istražuju djelovanja metoda iz okvira komplementarne i alternativne medicine ne bi li postigli bolju kontrolu bolesti te smanjili simptome iste. Istraživanja ukazuju na to da je do 70% bolesnika oboljelih od multiple skleroze u tijeku liječenja bolesti isprobalo jednu ili više metoda iz okvira komplementarne i alternativne medicine. Većina oboljelih od multiple skleroze koji su koristili metode komplementarne i alternativne medicine navodi da su iskusili neke povoljne učinke. Najčešće korištene metode komplementarne i alternativne medicine su dijeta, omega-3 masne kiseline i antioksidansi. Među metode koje bi mogle imati najviše potencijala u terapiji multiple skleroze, a za koje su potrebna daljnja istraživanja, ubrajaju se dijeta s malim udjelom masnoće, omega-3 masne kiseline, lipoična kiselina i nadomjesci vitamina D kao sredstva s protuupalnim i neuroprotektivnim djelovanjem kako u relapsnom, tako i u progresivnom obliku multiple skleroze. Dosad je provedeno nedovoljno istraživanja koja su za cilj imala procjenu sigurnosti i učinkovitosti komplementarne i alternativne medicine u liječenju multiple skleroze. Upravo zbog toga posljednjih nekoliko godina Nacionalno društvo za multiplu sklerozu aktivno podupire istraživanja u ovom vrlo važnom području

COVID-19 AND NEUROLOGICAL MANIFESTATIONS

Uvod: Krajem 2019. god. otkrivena je nova bolest nazvana COVID-19 (od engl. Corona Virus Disease-2019). Bolest je uzrokovana novim koronavirusom SARS-CoV-2 (od engl. Severe acute respiratory syndrome coronavirus 2), a s obzirom na brzo širenje od strane Svjetske zdravstvene organizacije (SZO) ubrzo je proglašena pandemija. Na početku pandemije ustanovljeno je da se COVID-19 osim dišnim simptomima može očitovati simptomima drugih organskih sustava. Između ostalog COVID-19 može se očitovati neurološkom simptomatologijom, a neurološki simptomi mogu se javiti i kao komplikacija COVID-19 te nakon preboljenja same bolesti. Cilj: nastojali smo prikupiti najnovije spoznaje o COVID-19 i neurološkim očitovanjima i komplikacijama. Također, željeli smo istaknuti i moguće razlike pri postavljanju dijagnoze i liječenja. Metode: Pretražili smo bibliografsku bazu podataka MEDLINE s ključnim riječima neurološki simptomi, komplikacije, COVID-19 sve do 2020. godine. Rezultati: Do sada su prema izvješću SZO ustanovljena 23 neurološka simptoma i 14 neuroloških dijagnoza. Prema podatcima SZO do sada je 1/3 hospitaliziranih bolesnika imala neurološke simptome. Kod bolesnika starijih od 66 godina najčešća je dijagnoza bila encefalopatija, a očitovala se agitacijom, smetenošću, delirijem te poremećajima stanja svijesti. Također, encefalopatija je bila pokazatelj lošijeg ishoda bolesti. Incidencija ishemijskih i hemoragijskih moždanih udara bila je veća kod COVID-19 pozitivnih bolesnika u odnosu na opću populaciju što se objašnjava proupalnim odgovorom i povećanom sklonosti koagulaciji tijekom bolesti. Prethodni čimbenici rizika za moždani udar kao što su pušenje, šećerna bolest i arterijska hipertenzija pridonose mehanizmu nastanka moždanog udara i lošijem ishodu. Manje učestali bili su neuromišićni poremećaji kao što su kljenut facijalnog živca i Gillian Barréov sindrom. Druge infektivne bolesti kao što je meningoencefalitis javljale su se rjeđe. Poremećaji mirisa i okusa obično bi se povukli unutar dva mjeseca. Dijagnostika i liječenje neuroloških očitovanja COVID-19 ne razlikuje se od uobičajenih postupaka. Nema specifičnog lijeka za liječenje neuroloških poremećaja tijekom COVID-19. Važno je napomenuti da bolesnici koji već imaju određenu neurodegenerativnu bolest i veći stupanj onesposobljenosti mogu imati lošiji ishod COVID-19. Također, kod dijela kroničnih neuroloških bolesti moguće je da se tijekom COVID-19 liječenje mora promijeniti. Zaključak: Tijekom pandemije neurolozi su se susreli i s različitim načinima reorganizacije bolničkog sustava liječenja neuroloških bolesnika, praćenja kroničnih neuroloških bolesnika, liječenja kroničnih bolesnika zbog pandemije te hitnih neuroloških stanja kod COVID-19 pozitivnih bolesnika. Zato je neurološka struka morala reorganizirati i osigurati neurološku dijagnostiku i liječenje za ostale bolesnike.Introduction: At the end of 2019, a new disease called COVID-19 was discovered. The disease was caused by the new coronavirus SARS-CoV-2. Due to its rapid spread, a global pandemic was soon declared by the World Health Organization (WHO). At the beginning of the pandemic, it was established that COVID-19 usually presented with respiratory symptoms but that it could also be presented with symptoms of other organs. COVID-19 can be manifested by neurological symptoms. Neurological symptoms can also occur as a complication due to COVID-19 and persist long after the disease has been overcome. Aim: We aimed to analyze scientifi c papers on neurological manifestations and complications in COVID-19 positive patients. We also wanted to highlight the possible differences in neurological diagnosis and treatment strategies. Methods: We searched MEDLINE database using the following key features: "neurological manifestations", "neurological symptoms" and "COVID-19" back to the year 2020. Results: According to a WHO report, 23 neurological symptoms and 14 neurological diagnoses have been described so far. One-third of hospitalized patients had neurological symptoms. Encephalopathy was the most common neurological condition in patients older than 66 years. Those patients presented with different symptoms including agitation, delirium, and consciousness disorders. According to some studies, encephalopathy was also a predictor of poor outcome. The number of cases of strokes (ischemic and hemorrhagic) was higher in COVID-19 positive patients than usual. This fact is explained by the tendency to a hypercoagulable state and proinfl ammatory process while having COVID-19. Also, a great number of patients have already had some risk factors (smoking, hypertension, diabetes mellitus), which contributed to the pathogenesis of stroke and also poorer outcomes. Less often neurological manifestations include neuromuscular disorders such as Guillain-Barré syndrome and facial palsy. Guillain-Barré syndrome mostly presented with sensorimotor manifestations. Other infective diseases such as meningoencephalitis occurred in rare cases. Hyposmia, anosmia, and dysgeusia occurred in most cases but resolved mostly within two months of infection. The diagnosis and treatment of neurological manifestations caused by COVID-19 do not differ from the usual diagnostic methods and treatment strategies. There is no specifi c drug to be used during COVID-19 infection and certain neurological diagnoses. Important information is that patients who already have certain neurodegenerative diseases and a higher degree of neurological disability may have worse outcome while having COVID-19. Also, in several neurological patients with a preexisting neurological diagnosis, the strategy and treatment of the underlying neurological disease had to change depending on whether or not the person had COVID-19. Conclusion: In conclusion, during the pandemic, neurologists met with different ways to reorganize the hospital system for treatment of neurological patients, monitoring of chronic neurological patients, treatment of chronic patients due to the pandemic, and emergency neurological conditions in COVID-19 positive patients. Also, the neurologists had to organize normal functioning of neurological diagnostic methods and treatment for other patients

Prvi bolnički registar bolesnika s multiplom sklerozom u Hrvatskoj

Th e fi rst hospital-based registry of patients with multiple sclerosis (MS) was established at the University Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia, in 2014. Th e aim of the registry was to continuously provide data on the number of hospital-managed MS patients, patterns of disease progression, predictors of disability progression, changes in lifespan and long-term outcomes. Relevant medical data included age and gender of MS patients, family history of MS, data on previous immunization, disease course, Expanded Disability Status Scale (EDSS) score, cerebral magnetic resonance imaging (MRI) lesion load quantification, and cerebrospinal fl uid analysis. Lifestyle habits in MS patients including smoking and alcohol consumption were also analyzed. All data were obtained from primary medical records between January 1, 2014 and January 1, 2015, and entered into the database. Data were evaluated retrospectively according to age and gender diff erences. Results showed that the majority of patients enrolled in the registry had the remitting relapsing course of disease, with low EDSS score indicating no disability or minimal disability. Cerebrospinal fl uid analysis showed that oligoclonal bands were present in the majority of MS patients, with aff ected blood-brain-barrier permeability. According to the remitting relapsing course of the disease, cerebral MRI quantitative analysis demonstrated a signifi cant lesion load in the majority of patients. When stratifi ed by lifestyle habits, smokers and alcohol consumers were more prevalent among male patients. Our hospital-based registry might be considered as a prototype for the national MS registry and should be improved for reliable statistical analysis.Prvi bolnički registar bolesnika s multiplom sklerozom (MS) u Hrvatskoj uspostavljen je 2014. godine u Klinici za neurologiju, Klinički bolnički centar “Sestre milosrdnice”, Zagreb. Cilj registra je kontinuirano prikupljanje podataka o broju hospitalno obrađenih bolesnika s MS, oblicima bolesti, prediktorima napredovanja onesposobljenosti, životnim navikama i dugoročnim ishodima za bolesnike. Relevantni medicinski podaci u registru MS uključivali su procjenu dobi i spola bolesnika, obiteljsku anamnezu na MS, podatke o prethodnim imunizacijama, tijeku bolesti, procjenu funkcionalne onesposobljenosti, kvantitativni prikaz lezija mozga magnetskom rezonancijom (MRI) i analizu cerebrospinalnog likvora. Nadalje, analizirane su životne navike bolesnika uključujući pušenje i konzumaciju alkohola. Svi podaci iz bolničke medicinske dokumentacije koji su prikupljeni od 1. siječnja 2014. godine do 1. siječnja 2015. godine upisani su u bazu podataka. Retrospektivno smo analizirali podatke prema dobi i spolu. Relevantni rezultati su pokazali da većina registriranih bolesnika ima relapsno remitirajući oblik bolesti s niskim stupnjem funkcionalne onesposobljenosti. Analiza cerebrospinalnog likvora u većine bolesnika pokazala je pozitivne oligoklonske vrpce i poremećenu propusnost krvno-moždane barijere. Kvantitativna MRI analiza mozga pokazala je značajno opterećenje brojem cerebralnih lezija u većine bolesnika, što odgovara relapsno remitirajućem obliku bolesti. Podjela prema životnim navikama pokazala je da je bilo više pušača i konzumenata alkohola u skupini muških bolesnika. Naš bolnički registar može poslužiti kao prototip za uspostavljanje nacionalnog registra MS, ali ga treba pobolj šati kako bi se osigurali svi potrebni podaci za pouzdanu statističku analizu podataka

NEUROLOGICAL MANIFESTATIONS OF POST-COVID-19 SYNDROME

Uvod: Krajem 2019. otkrivena je nova bolest nazvana COVID-19. Bolest je uzrokovana novim koronavirusom SARS-CoV-2. Ubrzo je Svjetska zdravstvena organizacija (SZO) proglasila pandemiju. Osim dišnih simptoma uočeno je da se bolest može očitovati i neurološkom simptomatologijom te da se tijekom i nakon liječenja COVID-19 mogu javiti neurološke komplikacije. Nakon preboljenja COVID-19, neovisno o težini kliničke slike, dio bolesnika žali se na zaostale neurološke simptome. U tim slučajevima govorimo o post-COVID-19 sindromu. Za simptome koji se javljaju tjednima ili mjesecima nakon COVID-19 simptoma u literaturi su korišteni različiti termini kao što su npr. od "dugi-COVID", "post–COVID sindrom", "posljedice SARSCoV-2 infekcije". Simptomi podrazumijevaju različita očitovanja organskih sustava koji se jave i/ili traju dulje od 4 tjedna. Cilj: Napraviti pregled trenutnih znanstvenih činjenica povezano sa sindromom post-COVID-19. Metode: Pretražili smo bazu podataka MEDLINE s ključnim riječima: post-COVID-19, neurološka očitovanja i dugi COVID-19 u vremenu od 2020. godine. Rezultati: Prema podatcima koje smo prikupili postoje četiri stadija COVID-19. Akutni COVID-19 podrazumijeva simptome i znakove bolesti koji traju do 4 tjedna. Produljeni simptomatski COVID-19 podrazumijeva simptome i znakove koji traju od 4 do12 tjedana. Post-COVID-19 sindrom podrazumijeva simptome i znakove koji se jave nakon akutne bolesti te traju dulje od 12 tjedana, a nisu objašnjeni drugom dijagnozom. Sindrom post-COVID-19 podrazumijeva znakove i simptome koji se pojavljuju tijekom ili nakon COVID-19 te traju dulje od 12 tjedana, a nisu objašnjeni drugom dijagnozom. Simptomi se mogu preklapati i varirati u intenzitetu. Dugi COVID podrazumijeva COVID-19 i sindrom post-COVID-19. Što se neuroloških post-COVID-19 očitovanja tiče, kod bolesnika su najčešće prisutni slabost i umor, mialgija, smetnje raspoloženja i smetnje spavanja. Također, u literaturi se navode i trajna glavobolja, smetnje koncentracije koje su nazvane moždanom maglom (od engl. brain fog), parestezije, poremećaj ili gubitak okusa, poremećaj ili gubitak mirisa te smetnje autonomnog živčanog sustava. Postoji nekoliko pretpostavljenih načina kojima virus dođe do središnjeg živčanog sustava: njušni, dišni i probavni. Središnji živčani sustav može biti oštećen izravno i neizravno. Moždana magla i smetnje pamćenja objašnjeni su središnjom i respiratornom hipoksijom te proupalnim odgovorom organizma. U slučaju sumnje na sindrom post-COVID-19 pri postavljanju dijagnoze uvijek treba uzeti u obzir i ostale moguće dijagnoze. U mnogim slučajevima potrebno je učiniti magnetsku rezonanciju (MR) mozga i vratne kralježnice. Ponekad je potrebno u dijagnosticiranje bolesti uključiti i ostale specijaliste. Zaključak: Sindrom post-COVID-19 može se očitovati nizom neuroloških poremećaja kao što su kognitivni simptomi, nesanica i promjene raspoloženja, disautonomija, smetnje mirisa i okusa, sindrom postintenzivne skrbi.Introduction: At the end of 2019, a new disease named COVID-19 was discovered. The disease is caused by the new coronavirus SARS-CoV-2. A global pandemic was soon declared by the World Health Organization (WHO). The disease mostly presents by respiratory simptoms. It can also be presented by neurological symptoms and neurological complications may occur during and after treatment of COVID-19. Regardless of COVID-19 symptoms, some patients complain of persistent symptoms. In such cases, we talk of so-called post-COVID-19 syndrome. Various terms have been used in the literature for the spectrum of symptoms that occur weeks or months after COVID-19 symptoms, such as "long-COVID", "post-COVID syndrome", "consequences of SARS-CoV-2 infection". Symptoms include various manifestations of organ systems that occur and/or last longer than 4 weeks. Aim: Our aim was to analyze scientifi c papers on the topic of post-COVID-19 syndrome. We also wanted to describe the proposed pathophysiological mechanisms of post-COVID-19 syndrome and highlight the possible diagnostic algorithm. Methods: We searched the MEDLINE database using the following key features:„postCOVID-19“, „neurological manifestations“ and „long-COVID-19“ back to the year 2020. Results: Accoding to our fi ndings, there are several stages of COVID-19. Acute COVID-19 includes acute disease that lasts for 4 weeks. Ongoing symptomatic COVID-19 includes symptoms that last for 4 to 12 weeks. Post-COVID-19 syndrome involves signs and symptoms that occur during or after COVID-19 infection, last for more than 12 weeks, and cannot be explained by another diagnosis. Symptoms can affect different organ systems and may overlap and fl uctuate in intensity. The term „long COVID-19“ describes ongoing symptomatic COVID-19 and post-COVID-19 syndrome. Neurological manifestations of post-COVID-19 syndrome include weakness and fatigue, myalgia, mood disorders, and sleep disturbances. Persistent headaches, impaired concentration ("brain fog"), paresthesias, dysgeusia, hyposmia and disorders of the autonomic nervous system have also been reported in the literature. There are several proposed routes for SARS-CoV-2 to reach the central nervosu system: olfactory, hematogenous and gastointestinal. The central nervous system can be damaged directly and indirectly. "Brain fog" and memory diffi culties are explained by central and respiratory hypoxia (especially), as well as proinfl ammatory body response. In case of post-COVID-19 neurolgical symptoms, there always have to be a diagnostic approach that considers and searches for alternative diagnosis in the patient context. Basic laboratory workup with possible later extension has to be done. Also, proper neuroimaging methods, mostly brain and/or spine magnetic resonance imaging, should be performed. In some cases, a multidisciplinary approach may be required. Conclusion: We have made a review of neurological postCOVID-19 symptoms and their pathophysiological mechanism with the initial care proposed. We would also like to note that there still are numerous data on the topic that will certainly be revealed with time