Central neurological complications and potential neuropathogenesis of COVID-19

Wang, Jianbo; Wang, Ping; Li, Chunyi; Huang, Yihuan; Yang, C. X.; Zhang, Lei

doi:10.1007/s11739-020-02476-z

Cited by 4 publications

(15 citation statements)

References 15 publications

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“…Statistics of the clinical symptoms of COVID-19 revealed that sputum production was more common in patients with moderate pneumonia, while headache appeared to be more pronounced in severe/critical patients. Some studies suggest that SARS-CoV-2 virus is not only con ned to the respiratory tract, but may also invade the central nervous system [34][35][36][37], and further studies are needed to clarify whether central nervous system infections are more pronounced in critically ill patients [38]. In addition, we similarly found that, the prevalence of comorbidities is found to be signi cantly different according to disease severity: higher in the severe/critical group.…”

Section: Discussionmentioning

confidence: 52%

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

Zeng

Jian

Zhong

et al. 2021

Preprint

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Background: COVID-19 had caused more than 2.8 million deaths globally, and the epidemic will persist for an extended period of time. We analyzed clinical features of patients in the early stage of the epidemic, so as to deepen the understanding of the disease.Methods: In this retrospective study, we included 84 confirmed cases of COVID-19 during February 1, 2020 and March 31, 2020. Baseline data were used to classify patients as moderate (57%) or severe/critical based on Chinese protocol. We focused on analyzing the differences in chest computed tomography (CT) between the two groups. Results: Of the 84 cases, 50 were male and the median age was 69 years. 55 (65%) patients had comorbidities at admission, more in the severe/critical group (P=0.040). 94% patients had bilateral lesions on CT, up to 68% had lesions involving all lobes. Ground glass opacification (GGO) (96%), consolidation (44%), Linear opacities (50%) and Air bronchogram (23%) were the mainly lesions. The lesion was gradually absorbed over time, but imaging abnormalities can persist for a long time. Compared with moderate cases, the severe/critical group had more pulmonary consolidation changes (P=0.044) and significantly higher CT severity Score (CTSS) (P=0.040). Lymphocyte counts were significantly lower (P=0.011) and NLR were higher (P=0.029) in severe/critical cases. Conclusions: Chest CT showed bilateral and multiple GGO and consolidation mainly. After treatment, pulmonary lesions were gradually absorbed over time, and imaging abnormalities can be persistent for a long time. Lung consolidation, CTSS, comorbidity, lymphocyte counts, and NLR may be predictors of severe COVID-19.

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Section: Discussionmentioning

confidence: 52%

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

Zeng

Jian

Zhong

et al. 2021

Preprint

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“…The neurotropic and neuroinvasive characteristics of the CoV family viruses 23 , 25 - 27 and the occurrence of symptoms associated with CNS involvement seem to support the real possibility of SARS-CoV-2 invading the brain and spinal regions. 14 , 19 - 21 , 28 …”

Section: Introductionmentioning

confidence: 86%

“… 55 Thus, profound vascular changes, including in large-caliber vessels, resulting from COVID-19 may be associated with the following factors: (i) endothelial inflammation 56 ; (ii) endothelial damage, which changes the vascular balance and generates vasoconstriction, ischemia, thrombus formation, and inflammation associated with edema 57 ; (iii) vasculitis 58 ; (iv) formation of thrombus in large vessels (aorta) due to the formation of neutrophil extracellular traps (NETs) and changes in the functioning of platelets and pro-coagulating factors. 13 , 23 - 25 , 55 , 59 , 71 Because of the weakening of the vessel wall and possible viral penetration, the virus can access nerve structures within the vessels, such as the aorta and the common carotid artery, which have neural circuits that integrate these vessels into the nucleus of the solitary tract (NTS) ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

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SARS-CoV-2 and Hypertension: Evidence Supporting Invasion into the Brain Via Baroreflex Circuitry and the Role of Imbalanced Renin-Angiotensin-Aldosterone-System

et al. 2023

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Hypertension is considered one of the most critical risk factors for COVID-19. Evidence suggests that SARS-CoV-2 infection produces intense effects on the cardiovascular system by weakening the wall of large vessels via vasa-vasorum. In this commentary, we propose that SARS-CoV-2 invades carotid and aortic baroreceptors, leading to infection of the nucleus tractus solitari (NTS) and paraventricular hypothalamic nucleus (PVN), and such dysregulation of NTS and PVN following infection causes blood pressure alteration at the central level. We additionally explored the hypothesis that SARS-CoV-2 favors the internalization of membrane ACE2 receptors generating an imbalance of the renin-angiotensin-aldosterone system (RAAS), increasing the activity of angiotensin II (ANG-II), disintegrin, and metalloproteinase 17 domain (ADAM17/TACE), eventually modulating the integration of afferents reaching the NTS from baroreceptors and promoting increased blood pressure. These mechanisms are related to the increased sympathetic activity, which leads to transient or permanent hypertension associated with SARS-CoV-2 invasion, contributing to the high number of deaths by cardiovascular implications.

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“…Also, there is evidence of ocular surface infection in patients with COVID-19, and SARS-CoV-2 RNA was detected in eye secretions of a patient [98]. However, it is still unclear if SARS-CoV-2 is neurotropic in humans and whether it can penetrate the CNS via retrograde neuronal route [99]. Olfactory dysfunction is one of the most common symptoms in COVID-19.…”

Section: Neurological Involvement In Covid-19mentioning

confidence: 99%

A narrative review of coronavirus disease 2019 (COVID-19): clinical, epidemiological characteristics, and systemic manifestations

et al. 2021

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Coronavirus disease 2019 (COVID-19) is an emerging infectious disease which has had a rapid surge in cases and deaths since it is first documented in Wuhan, China, in December 2019. COVID-19 is caused by the Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 uses angiotensin-converting enzyme 2, which is highly expressed in the human lower respiratory tract but also in other tissues, as the cellular entry receptor. Thus, COVID-19 mainly affects the respiratory system but can cause damage to other body systems, including the cardiovascular, gastrointestinal, hepatobiliary, renal, and central nervous systems. We review the pathogenesis and clinical manifestations of the infection, focusing on our current understanding of the disease mechanisms and their translation to clinical outcomes, as well as adverse effects on different body systems. We also discuss the epidemiology pathogenesis, clinical, and multi-organ consequences, and highlight some of the research gaps regarding COVID-19.

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Central neurological complications and potential neuropathogenesis of COVID-19

Cited by 4 publications

References 15 publications

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

SARS-CoV-2 and Hypertension: Evidence Supporting Invasion into the Brain Via Baroreflex Circuitry and the Role of Imbalanced Renin-Angiotensin-Aldosterone-System

A narrative review of coronavirus disease 2019 (COVID-19): clinical, epidemiological characteristics, and systemic manifestations

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