Neurological manifestations of COVID-19, SARS and MERS
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REVIEW ARTICLE
Neurological manifestations of COVID‑19, SARS and MERS Verstrepen Kato1,2 · Baisier Laure1,2 · De Cauwer Harald1,2 Received: 5 April 2020 / Accepted: 12 June 2020 © Belgian Neurological Society 2020
Abstract Since December 2019, the world is affected by an outbreak of a new disease named COVID-19, which is an acronym of ‘coronavirus disease 2019’. Coronaviruses (CoV) were assumed to be associated with mild upper respiratory tract infections, such as common cold. This perception changed in time due to occurrence of the Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV in 2002 and the Middle East Respiratory Syndrome (MERS) caused by MERS-CoV in 2012, both inducing an epidemic severe viral pneumonia with potentially respiratory failure and numerous extra-pulmonary manifestations. The novel coronavirus, SARS-CoV-2, is likewise a causative pathogen for severe viral pneumonia with the risk of progression to respiratory failure and systemic manifestations. In this review, we will give a summary of the neurological manifestations due to SARS and MERS, as those might predict the neurological outcome in the novel COVID-19. Additionally, we provide an overview of the current knowledge concerning neurological manifestations associated with COVID-19, to the extent that literature is already available as the pandemic is still ongoing. Keywords Neurology · COVID-19 · SARS · MERS · Stroke · Neuropathy
Introduction Viruses of the Coronaviridae family are positive-sensed, single-stranded RNA viruses. They are broadly distributed in different animal species including avian host, cats, dogs, bats, camels, cattle and mice. Among these viruses, some are pathogenic to human [1–3]. In humans, CoV infections were primarily associated with upper respiratory tract and gastrointestinal tract infections. However, the last 2 decades the world was affected by several viral epidemics, such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) in 2002−2003 and Middle East Respiratory Syndrome Coronavirus (MERSCoV) in 2012, both resulting in high mortality rate, respectively, 10% and 35%. Since December 2019, the world is affected by an outbreak of a new disease named COVID-19, which is an acronym of ‘coronavirus disease 2019’. It is caused by a novel * De Cauwer Harald [email protected] 1
Department of Neurology, Dimpna Regional Hospital, JB Stessenstraat 2, 2440 Geel, Belgium
Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
2
coronavirus (CoV), named SARS-CoV-2, due to similarities with the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) [1]. All three infections show a broad spectrum of clinical manifestation, varying from asymptomatic or mild disease to severe illness with risk of progress to respiratory failure due to viral pulmonary infection [4, 5]. It is known that human coronaviruses can reach the central nervous system (CNS) and that they could be associated with neurological symptoms [6]. Several cases of neurological involvement durin
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