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Neuropathogenesis and Neurological Manifestations of SARS-CoV-2

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COVID-19 Critical and Intensive Care Medicine Essentials

Abstract

Neurological complications of COVID-19 contribute significantly to mortality in the intensive care unit (ICU). Preventive therapy, though discussed in literature, is limited for COVID-19 neurological manifestations and treatment algorithms continue to rely on evidence from previous pandemics. Thus, in this chapter we evaluate current in vitro, in vitro, histopathological studies to ascertain the most likely mechanisms of SARS-CoV-2 central nervous system entry. From this understanding, we determine probable mechanisms for neurological compilations observed in COVID-19 as relevant to the clinician. SARS-CoV-2 infection of nasal epithelium and the respiratory tract may allow for a systemic inflammatory response that results in neuroinflammation. While most neurological complications are inflammatory in etiology, rarely, SARS-CoV-2 may enter into the central nervous system and mediate neuronal damage.

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Abbreviations

ACE-2:

Angiotensin converting enzyme-2 cellular receptor

BBB:

Blood–brain-barrier

B-CSF-B:

Blood–cerebrospinal fluid-barrier

COVID-19:

Coronavirus Disease 2019

CSF:

Cerebrospinal fluid

CNS:

Central nervous system

ICH:

Intracranial hemorrhage

MRI:

Magnetic resonance imaging

OSNs:

Olfactory sense neurons

OE:

Olfactory epithelium

SARS-CoV-2:

Severe acute respiratory syndrome Coronavirus 2

TMPRSS-2:

Transmembrane protease, serine 2

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Source of Funding

None.

Conflicts of Interest/Disclosures

Sung-Min Cho has nothing to disclose. Rakesh C. Arora has received an unrestricted educational grant from Pfizer Canada Inc. and honoraria from Abbott Nutrition, Edwards Lifesciences, and Mallinckrodt Pharmaceuticals for work unrelated to this chapter. Lavien Premraj has nothing to disclose.

Author information

Authors and Affiliations

  1. Griffith University School of Medicine, Gold Coast, QLD, Australia

    Lavienraj Premraj

  2. Cardiac Science Program, St Boniface General Hospital Research Centre, Winnipeg, MB, Canada

    Rakesh C. Arora

  3. University of Manitoba, Winnipeg, MB, Canada

    Rakesh C. Arora

  4. University of Toronto, Toronto, ON, Canada

    Rakesh C. Arora

  5. Neuroscience Critical Care and Cardiac Surgery Division, Departments of Neurology, Neurosurgery, Surgery, and Anaesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Sung-Min Cho

Authors
  1. Lavienraj Premraj
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Correspondence to Sung-Min Cho .

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Editors and Affiliations

  1. Anesthesia and Critical Care Unit, Ospedale San Martino, Genova, Italy

    Denise Battaglini

  2. Anesthesia and Critical Care, Ospedale San Martino, Genoa, Italy

    Paolo Pelosi

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Premraj, L., Arora, R.C., Cho, SM. (2022). Neuropathogenesis and Neurological Manifestations of SARS-CoV-2. In: Battaglini, D., Pelosi, P. (eds) COVID-19 Critical and Intensive Care Medicine Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-94992-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-94992-1_8

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