神经病学和神经科学杂志

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Neurological Manifestations of SARS-CoV-2: A Proposed Pathogenesis

Ortiz Juan Fernando,  Maria Beter, Feiyang Tao, Willian Tambo,  Carolina Cozar, and  Marcos A. Sanchez-Gonzalez  

Background: Severe acute respiratory syndrome (SARS-CoV-2) is a worldwide pandemic, was first reported in Wuhan, China. SARS-CoV-2 mainly affects the respiratory tract, but the nervous system is not immune to the effects of the virus.

Objective: To consolidate the knowledge of the effects of SARS-CoV-2 on the nervous system, subcategorized the manifestations were established as a central and peripheral possible pathogenic pathway of the virus on the nervous system.

Methods: A search strategy was made using PubMed, Google Scholar, and Medline using a combination of search terms: Coronavirus, Encephalitis, SARSCoV- 2, Delirium, and Gilliam Barre, Anosmia, Stroke, Miller Fisher. We reviewed only studies published in English between 2019 and 2020. Central nervous manifestations were subcategorized in central nervous system manifestations (CNM) and peripheral nervous system manifestations (PNM). The topics studied in each section were: delirium, headaches, encephalitis, acute necrotizing encephalitis, stroke for (CNM) and anosmia, dysgeusia, Guillain Barré, and Miller Fisher Syndrome for (PNM). A proposed pathogenic mechanism and the main clinical features in each section were described.

Discussion: Central Nervous manifestations are due to 3 mechanisms: invasion of the virus through ACE receptor, cytokine storm, and immune dysregulations while peripheral Nervous System manifestations are due to virus invasion in the epithelium mucosa and olfactory bulb, but also a central component could play a role. Additionally, molecular mimicry plays an essential role in the development of Guillain Barré and Miller Fisher.

Conclusion: More research needs to be done regarding the pathogenesis of neurological components of SARS-Co-2. Overall, there is no common pathway for the pathogenesis for all the components of the neurological manifestations of SARS-CoV-2. Each component has its own pathogenesis, but some neurological manifestations share common features.