Update on Neurological Manifestations of SARS-CoV-2
Hisham M Valiuddin 1, Almir Kalajdzic 2, James Rosati 2, Kevin Boehm 3, Dominique Hill 2Affiliations expand
- PMID: 33052822
- PMCID: PMC7673884
- DOI: 10.5811/westjem.2020.8.48839
Free PMC article
Abstract
Severe acute respiratory syndrome coronavirus 2, the source of COVID-19, causes numerous clinical findings including respiratory and gastrointestinal findings. Evidence is now growing for increasing neurological symptoms. This is thought to be from direct in-situ effects in the olfactory bulb caused by the virus. Angiotensin-converting enzyme 2 receptors likely serve as a key receptor for cell entry for most coronaviridae as they are present in multiple organ tissues in the body, notably neurons, and in type 2 alveolar cells in the lung. Hematogenous spread to the nervous system has been described, with viral transmission along neuronal synapses in a retrograde fashion. The penetration of the virus to the central nervous system (CNS) allows for the resulting intracranial cytokine storm, which can result in a myriad of CNS complications. There have been reported cases of associated cerebrovascular accidents with large vessel occlusions, cerebral venous sinus thrombosis, posterior reversible encephalopathy syndrome, meningoencephalitis, acute necrotizing encephalopathy, epilepsy, and myasthenia gravis. Peripheral nervous system effects such as hyposmia, hypogeusia, ophthalmoparesis, Guillain-Barré syndrome, and motor peripheral neuropathy have also been reported. In this review, we update the clinical manifestations of COVID-19 concentrating on the neurological associations that have been described, including broad ranges in both central and peripheral nervous systems.
Conflict of interest statement
Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.
Similar articles
- Spectrum of Neurological Manifestations in Covid-19: A Review.Garg RK.Neurol India. 2020 May-Jun;68(3):560-572. doi: 10.4103/0028-3886.289000.PMID: 32643664 Review.
- Involvement of the nervous system in COVID-19: The bell should toll in the brain.Satarker S, Nampoothiri M.Life Sci. 2020 Dec 1;262:118568. doi: 10.1016/j.lfs.2020.118568. Epub 2020 Oct 6.PMID: 33035589 Free PMC article. Review.
- Impact of COVID-19 on the cerebrovascular system and the prevention of RBC lysis.Akhter N, Ahmad S, Alzahrani FA, Dar SA, Wahid M, Haque S, Bhatia K, Sr Almalki S, Alharbi RA, Sindi AAA.Eur Rev Med Pharmacol Sci. 2020 Oct;24(19):10267-10278. doi: 10.26355/eurrev_202010_23251.PMID: 33090438 Review.
- Autonomic dysfunction heralding acute motor axonal neuropathy in COVID-19.Ghosh R, Roy D, Sengupta S, Benito-León J.J Neurovirol. 2020 Dec;26(6):964-966. doi: 10.1007/s13365-020-00908-2. Epub 2020 Sep 11.PMID: 32918164 Free PMC article.
- Severe acute respiratory syndrome coronavirus 2 may be an underappreciated pathogen of the central nervous system.Alam SB, Willows S, Kulka M, Sandhu JK.Eur J Neurol. 2020 Nov;27(11):2348-2360. doi: 10.1111/ene.14442. Epub 2020 Aug 14.PMID: 32668062 Free PMC article. Review.
