Abstract
Increasing evidence suggests that Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) can also invade the central nervous system (CNS). However, findings available on its neurological manifestations and their pathogenic mechanisms have not yet been systematically addressed. A literature search on neurological complications reported in patients with COVID-19 until June 2020 produced a total of 23 studies. Overall, these papers report that patients may exhibit a wide range of neurological manifestations, including encephalopathy, encephalitis, seizures, cerebrovascular events, acute polyneuropathy, headache, hypogeusia, and hyposmia, as well as some non-specific symptoms. Whether these features can be an indirect and unspecific consequence of the pulmonary disease or a generalized inflammatory state on the CNS remains to be determined; also, they may rather reflect direct SARS-CoV-2-related neuronal damage. Hematogenous versus transsynaptic propagation, the role of the angiotensin II converting enzyme receptor-2, the spread across the blood-brain barrier, the impact of the hyperimmune response (the so-called “cytokine storm”), and the possibility of virus persistence within some CNS resident cells are still debated. The different levels and severity of neurotropism and neurovirulence in patients with COVID-19 might be explained by a combination of viral and host factors and by their interaction.
Highlights
There are limitations in the epidemiological studies carried on COVID-19, as well as limited case records for determining the actual incidence of these complications, some patients reported neurological symptoms, but clinical findings and pathogenic features have not yet systematically addressed
In the case of Severe Acute Respiratory Syndrome (SARS)-Clinical FeaturesCoronaviruses (CoVs)-2, the existence of these phenomena is supported by previous evidence showing human central nervous system (CNS) infection from other respiratory viruses, the CNS of other species infected by CoVs, animal and in vitro models of CNS infection by human CoVs, and the occurrence of neurological complications in the course of other human CoVs infections
A PubMed-based literature search was performed to find all relevant reports published until JuneA20P2u0b.MTehde-bsaesaerdchliteqruaeturireessewaercrhe w“CasOpVeIrDfo-r1m9 eAd NtoDfinnderavllorueslevsaynsttermep”o, r“tsbprauibnl”is, h“endeuunrotilloJguyn”e, 2“0n2e0u.rTohloegsiecaarlc”h, “qeunecrieepshwaelorepa“tChOy”V,ID“e-1n9ceApNhaDlintiesr”v,o“usstrsoykstee”m, “”,se“ibzruarines””,“n“enueruorloopgayt”h, y“”n.euTrhoelosgeiacarcl”h, “wenasceaplshoalroeppaetahtyed”, b“yenucseipnhgatlhiteisa”b, o“svter-omkee”n,ti“osneeizdukreesy”w, “onrdeusraonpdatthhye”t.eTrmhe“sSeAarRcSh-CwoaVs -a2l”soinrestpeeaadteodf b“yCOusVinIDg-t1h9e”a. bove-mentioned keywords and the term “SARS-CoV-2” instead of “COVID-19”
Summary
Coronaviruses (CoVs) are a group of large enveloped non-segmented positive-sense RNA viruses, causing respiratory and enteric diseases in animals and humans [1]. The initial cases, presenting with a dry cough, sore throat, fever, dyspnea, and bilateral lung infiltrates on chest imaging, were all linked to the Wuhan’s Huanan Seafood Wholesale Market, which trades fish and a variety of live animals, including bats, poultry, marmots, and snakes [2]. This novel CoV has caused an outbreak of severe pneumonia (called COVID-19) in China, that has rapidly spread around the world [3]. The overall mortality is estimated to be 8% and is due to respiratory failure or multiple organ failure [9,10]
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