Comprehensive Review on Neuro-COVID-19 Pathophysiology and Clinical Consequences.

Helia Jafari Khaljiri,Milad Moradi,Monire Jamalkhah,Hossein Pakdaman,Ali Amini Harandi,Ashkan Mowla

doi:10.1007/s12640-021-00389-z

Abstract

Aside from the respiratory distress as the predominant clinical presentation of SARS-CoV-2 infection, various neurological complications have been reported with the infection during the ongoing pandemic, some of which cause serious morbidity and mortality. Herein, we gather the latest anatomical evidence of the virus’s presence within the central nervous system. We then delve into the possible SARS-CoV-2 entry routes into the neurological tissues, with the hematogenous and the neuronal routes as the two utmost passage routes into the nervous system. We then give a comprehensive review of the neurological manifestations of the SARS-CoV-2 invasion in both the central and peripheral nervous system and its underlying pathophysiology via investigating large studies in the field and case reports in cases of study scarcity.

Highlights

In 2019, novel cases of pneumonia of unknown cause in Wuhan, China, were reported (Disease outbreak news 2019) (Disease (Disease outbreak news 2019), and later that year, the underlying pathogen was designated as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
Alongside the fact that immunohistochemical analysis of the neurons, glia, endothelium, or immune cells in neither of specimens stained positive for SARS-CoV-2, Solomon et al (2020) concluded that neuropathological manifestations in COVID-19 patients predominantly rely on hypoxia-related complications rather than encephalitis or other specific brain changes referable to the virus (Solomon et al 2020)
In another study based in the USA, 27 of 76 SARS-COV-2-positive patients showed neurological manifestation, of whom 20 were diagnosed with COVID-19-associated encephalopathy and two with COVID-19-associated acute necrotizing encephalopathy (Scullen et al 2020)

Summary

Introduction

In 2019, novel cases of pneumonia of unknown cause in Wuhan, China, were reported (Disease outbreak news 2019) (Disease (Disease outbreak news 2019), and later that year, the underlying pathogen was designated as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Multiple studies reported intracerebral hemorrhage as a neurological manifestation of SARS-CoV-2 CNS infection. Alongside the fact that immunohistochemical analysis of the neurons, glia, endothelium, or immune cells in neither of specimens stained positive for SARS-CoV-2, Solomon et al (2020) concluded that neuropathological manifestations in COVID-19 patients predominantly rely on hypoxia-related complications rather than encephalitis or other specific brain changes referable to the virus (Solomon et al 2020).

Results

Conclusion