UMEM Educational Pearls

Title: Potential Neurologic Involvement of COVID-19?

Category: Neurology

Keywords: Coronavirus, SARS, SARS-CoV, COVID-19, SARS-CoV-2 (PubMed Search)

Posted: 3/25/2020 by WanTsu Wendy Chang, MD (Updated: 11/21/2024)
Click here to contact WanTsu Wendy Chang, MD

Human coronaviruses generally cause GI and respiratory diseases.
However, myocarditis, meningitis, and multi-organ failure have also been reported.
Like other viruses, human coronaviruses may enter the central nervous system (CNS) hematogenously or through neuronal retrograde.
The novel coronavirus (SARS-CoV-2) that emerged in Wuhan, China in December 2019 shares similar pathogenesis with SARS-CoV and MERS-CoV, and has been identified to use the same ACE2 receptor as SARS-CoV.
Experimentally, SARS-CoV has been shown to cause neuronal death by invading the brain close to the olfactory epithelium.
Patients with SARS have also been found to have the virus in their cerebrospinal fluid (CSF).
An altered sense of smell, or hyposmia, has been observed in COVID-19 and may warrant an evaluation for potential CNS involvement.

Bottom Line: SARS-CoV has been associated with CNS involvement. Given their similar pathogenesis and finding of hyposmia in COVID-19, SARS-CoV-2 may be associated with risk of CNS involvement.

References

Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020 Mar 13 [Online ahead of print]
Li Y-C, Bai W-Z, Hashikawa T. The neuroinvasiveness potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020 Feb 27 [Epub ahead of print]
Desforges M, Le Coupanec A, Dubeau P, et al. Human coronaviruses and other respiratory viruses: Underestimated opportunistic pathogens of the central nervous system? Viruses. 2019;12(1):14.

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