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URL: https://pubmed.ncbi.nlm.nih.gov/32652139/

⇱ Update on neurological manifestations of COVID-19 - PubMed

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Abstract

Novel coronavirus (severe acute respiratory syndrome coronavirus-2: SARS-CoV-2) has a high homology with other cousin of coronaviruses such as SARS and Middle East respiratory syndrome-related coronavirus (MERS). After outbreak of the SARS-CoV-2 in China, it has spread so fast around the world. The main complication of coronavirus disease 2019 (COVID-19) is respiratory failure, but several patients have also been admitted to the hospital with neurological symptoms. Direct invasion, hematogenic rout, retrograde and anterograde transport along peripheral nerves are considered as main neuroinvasion mechanisms of SARS-CoV-2. In the present study, we describe the possible routes for entering of SARS-CoV-2 into the nervous system. Then, the neurological manifestations of the SARS-CoV-2 infection in the central nervous system (CNS) and peripheral nervous system (PNS) are reviewed. Furthermore, the neuropathology of the virus and its impacts on other neurological disorders are discussed.

Keywords: Nervous system; Neuroinvasion; Neurological symptoms; Novel coronavirus.

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Fig. 1
The immune pathogenesis of COVID-19 in the CNS. Hypoxia is considered as a key player in COVID-19 associated CNS pathology. Alveolar dysfunction results in brain hypoxia that is followed by cerebral vasodilation, increased anaerobic metabolism, and ischemia. On the other hand, over-activation of the immune system and increased release of inflammatory cytokines and chemokines such as interleukins 2, 6, 7, and 10, tumor necrotizing α, and granulocyte colony-stimulating factor change the blood brain barrier permeability and these factors allow the virus to enter into the central nervous system. Moreover, some of these cytokines activate glutamate receptors and cause neuronal hyper-excitability, leading to acute seizures.

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