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)
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  • 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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