Update on neurological manifestations of COVID-19

• Published in: Life sciences (1973) Vol. 257; p. 118063
• Main Authors: Yavarpour-Bali, Hanie, Ghasemi-Kasman, Maryam
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 15.09.2020; Elsevier BV
• Subjects: Anterograde transport; Betacoronavirus - immunology; Betacoronavirus - pathogenicity; Central nervous system; Central Nervous System - virology; China - epidemiology; Coronaviridae; Coronavirus - immunology; Coronavirus - pathogenicity; Coronavirus Infections - epidemiology; Coronavirus Infections - immunology; Coronavirus Infections - pathology; Coronaviruses; COVID-19; Cytokines - immunology; Cytokines - metabolism; Homology; Humans; Invasiveness; Nervous system; Nervous System Diseases - epidemiology; Nervous System Diseases - virology; Neuroinvasion; Neurological diseases; Neurological symptoms; Novel coronavirus; Pandemics; Peripheral nerves; Peripheral nervous system; Peripheral Nervous System - virology; Pneumonia, Viral - epidemiology; Pneumonia, Viral - immunology; Pneumonia, Viral - pathology; Respiratory diseases; SARS-CoV-2; Severe acute respiratory syndrome; Severe Acute Respiratory Syndrome - epidemiology; Severe Acute Respiratory Syndrome - virology; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Viral diseases; Viruses; China; Nervous system; Neurological symptoms; Neuroinvasion; Novel coronavirus
• ISSN: 0024-3205; 1879-0631
• DOI: 10.1016/j.lfs.2020.118063

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. Different routes for entering of SARS-CoV-2 to the nervous system. 1) Neuronal pathway: SARS-CoV-2 may enter to the nervous tissue through retrograde and anterograde transport along peripheral nerves. The SARS-CoV-2 may infect the olfactory bulb through TMPRSS2 and ACE2 receptors. Moreover, the virus may transfer through extracellular vesicle (EVs) in the olfactory ensheathing cells (OECs) which is independent to the ACE2 receptors. In addition to olfactory nerve, the virus can transport via trigeminal and vagus nerves. Interestingly, viral infection of cardio-respiratory center in the brain stem may relate with the respiratory failure. (2) Blood circulation pathway: the virus may use blood stream to enter the central nervous system (CNS). The virus (either in blood stream or cerebrospinal fluid) infects epithelial cells of the blood-cerebrospinal fluid barrier (BCSFB) in the choroid plexus (CP) of the brain's ventricles. [Display omitted]