Neurological consequences of COVID-19: what have we learned and where do we go from here?
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(2020) 17:286
REVIEW
Open Access
Neurological consequences of COVID-19: what have we learned and where do we go from here? Abbas Jarrahi1†, Meenakshi Ahluwalia2†, Hesam Khodadadi3, Evila da Silva Lopes Salles3, Ravindra Kolhe2, David C. Hess4, Fernando Vale1, Manish Kumar5, Babak Baban3, Kumar Vaibhav1 and Krishnan M. Dhandapani1*
Abstract The coronavirus disease-19 (COVID-19) pandemic is an unprecedented worldwide health crisis. COVID-19 is caused by SARS-CoV-2, a highly infectious pathogen that is genetically similar to SARS-CoV. Similar to other recent coronavirus outbreaks, including SARS and MERS, SARS-CoV-2 infected patients typically present with fever, dry cough, fatigue, and lower respiratory system dysfunction, including high rates of pneumonia and acute respiratory distress syndrome (ARDS); however, a rapidly accumulating set of clinical studies revealed atypical symptoms of COVID-19 that involve neurological signs, including headaches, anosmia, nausea, dysgeusia, damage to respiratory centers, and cerebral infarction. These unexpected findings may provide important clues regarding the pathological sequela of SARS-CoV-2 infection. Moreover, no efficacious therapies or vaccines are currently available, complicating the clinical management of COVID-19 patients and emphasizing the public health need for controlled, hypothesisdriven experimental studies to provide a framework for therapeutic development. In this mini-review, we summarize the current body of literature regarding the central nervous system (CNS) effects of SARS-CoV-2 and discuss several potential targets for therapeutic development to reduce neurological consequences in COVID-19 patients. Keywords: SARS-CoV-2, ARDS, Neurotropism, Coronavirus, Coagulopathy, Neutrophil extracellular traps, Stroke, Cytokine storm, Neuroinflammation
Introduction A series of pneumonia cases of unknown origin emerged in December 2019 at Wuhan, China, resembling the recent severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) outbreaks [1–5]. Genetic sequencing of samples derived from infected patients subsequently identified the pathogen as a novel * Correspondence: [email protected] † The authors Abbas Jarrahi and Meenakshi Ahluwalia contributed equally and should be considered co-first authors. 1 Department of Neurosurgery, Medical College of Georgia, Augusta University, 1120 15th Street, 30912 Augusta, Georgia Full list of author information is available at the end of the article
coronavirus, initially named 2019 novel coronavirus (2019-nCoV), with the associated disease called coronavirus disease-19 (COVID-19) [6]. Given the genetic similarity to SARS-CoV, the nomenclature of the novel coronavirus was later revised to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses. Coronaviruses, enveloped positive-sense RNA viruses belonging to family Coronaviridae and the order Nidovirales, are widely infectious across species [7]. Inde
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