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

Numerous experimental and clinical studies have proven that the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a tropism for the nervous system. The infection of the nervous system by SARS-CoV-2 can occur via the nasal route through trans -synaptic pathways. Coronaviruses can infect neurons and glial cells through angiotensin-converting 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 COVID-19 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-Barre syndrome are related to SARS-CoV-2 infection. In this review, we focused on the currently known neurological manifestations of COVID-19, which could be considered mainly in asymptomatic patients with COVID-19 and, if noted, may limit the transmission of coronavirus infection.

Automated summary

SARS-CoV-2 has a tropism for the nervous system, infecting neurons and glial cells through the nasal route, leading to neuroinflammatory responses and damage to brain stem cells; in addition, the infection causes various neurological symptoms such as headache, dizziness, and loss of taste.