Neurological symptoms as a clinical manifestation of coronavirus disease 2019: implications for internists.

ABSTRACT

Numerous experimental and clinical studies have proven that the new severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) has a tropism for the nervous system. The infection of the nervous system by SARS­CoV­2 can occur via the nasal route through trans­synaptic pathways. Coronaviruses can infect neurons and glial cells through angiotensin­converting enzyme 2 receptors or by endocytosis. The infection of the central nervous system accompanied by coronavirus disease 2019-related systemic inflammation leads to the impairment of the blood-brain barrier and triggers a neuroinflammatory response with reactive astrogliosis and microglial activation. In addition, brain stem cells are being damaged, which results in respiratory distress. Apart from typical symptoms of COVID­19 associated with the involvement of the respiratory system, neurological manifestations such as headache, dizziness, myalgia, anosmia, ageusia, encephalopathy, encephalitis, stroke, epileptic seizures, rhabdomyolysis, and Guillain-Barré syndrome are related to SARS­CoV­2 infection. In this review, we focused on the currently known neurological manifestations of COVID­19, which could be considered mainly in asymptomatic patients with COVID­19 and, if noted, may limit the transmission of coronavirus infection.