Pathological and clinical implications of neurological manifestations of COVID-19 infections

What is it about?

Coronaviruses, the group of viruses that includes the COVID-19 virus, are known to have a significant impact on human physiology. The damaging effect of human coronaviruses (HCoV) on respiratory organs and the associated clinical features are well studied. However, the involvement of the central nervous system (CNS), known to be critical for HCoV infection, has not attracted adequate clinical focus. To fill this gap, the authors of this paper examined representative case reports of various CNS-related symptoms in patients with various HCoV infections. They suggest a ‘neuroinvasive’ mechanism of the COVID-19 that may be the potential cause for the observed surge of these symptoms during the current pandemic. This neuroinvasion is suggested to be either through a ‘retrograde transsynaptic route’ via different receptors in the nose, or through infections of the thalamus and brain stem.

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Photo by Hal Gatewood on Unsplash

Photo by Hal Gatewood on Unsplash

Why is it important?

Coronavirus infections have historically shown a strong association, having been noted as early as the 1980s, when two coronavirus strains isolated from patients with multiple sclerosis could be neutralized using the patients’ serum. Coming to the present, patients with severe COVID-19 infection show more CNS-related events than patients with mild-to-moderate infection. In these severe cases, the temporal lobe, basal ganglia, and periventricular region of the brain have shown abnormalities. The high transmission of COVID-19 and the extensive CNS-related symptoms, combined with the historically established association of coronaviruses and the CNS, together underscore the need for developing a new staging system for a therapeutic approach combining CNS and respiratory treatment of patients with COVID-19 infection. KEY TAKEAWAY The expanded spectrum of neurological symptoms of COVID-19 infection calls for a deeper clinical understanding of the pathophysiology of COVID-19 and newer therapeutic innovations to tackle both respiratory and neurological symptoms.