Neurological manifestations of patients with COVID-19: potential routes of SARS-CoV-2 neuroinvasion from the periphery t
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REVIEW
Neurological manifestations of patients with COVID-19: potential routes of SARS-CoV-2 neuroinvasion from the periphery to the brain Zhengqian Li1,*, Taotao Liu1,*, Ning Yang1, Dengyang Han1, Xinning Mi1, Yue Li1, Kaixi Liu1, Alain Vuylsteke2,
Hongbing Xiang (✉)3, Xiangyang Guo (✉)1
1
Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China; 2Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; 3Department of Anesthesiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
© Higher Education Press 2020
Abstract Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global pandemic in only 3 months. In addition to major respiratory distress, characteristic neurological manifestations are also described, indicating that SARS-CoV-2 may be an underestimated opportunistic pathogen of the brain. Based on previous studies of neuroinvasive human respiratory coronaviruses, it is proposed that after physical contact with the nasal mucosa, laryngopharynx, trachea, lower respiratory tract, alveoli epithelium, or gastrointestinal mucosa, SARS-CoV-2 can induce intrinsic and innate immune responses in the host involving increased cytokine release, tissue damage, and high neurosusceptibility to COVID-19, especially in the hypoxic conditions caused by lung injury. In some immunecompromised individuals, the virus may invade the brain through multiple routes, such as the vasculature and peripheral nerves. Therefore, in addition to drug treatments, such as pharmaceuticals and traditional Chinese medicine, non-pharmaceutical precautions, including facemasks and hand hygiene, are critically important. Keywords
coronavirus disease 2019 (COVID-19); SARS-CoV-2; neurological manifestations; neuroinvasion; brain
Introduction By March 29, 2020, the coronavirus disease 2019 (COVID-19) outbreak had caused 634 835 confirmed cases and 29 957 deaths globally, more than caused by severe acute respiratory syndrome (SARS) (8273 cases, 775 deaths) in 2003 and Middle East respiratory syndrome (MERS) (1139 cases, 431 deaths) in 2013. Currently, there is no confirmed effective therapeutic strategy for COVID19 because the mechanism and progress of its pathology are poorly understood. The pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is
Received March 25, 2020; accepted April 3, 2020 Correspondence: Xiangyang Guo, [email protected]; Hongbing Xiang, [email protected] *
Zhengqian Li and Taotao Liu contributed equally to this article and should
be considered co-first authors.
highly pathogenic and transmissible, creating severe challenges for the whole world. The most prevalent COVID-19 symptoms are respiratory system dysfunction, fever, and cough, and most of COVID-19 patients had abnormal computerized tomography chest examinations. Most deaths of COVID-19 patients are associated with dyspnea. Some patients with SARS-CoV-2 i
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