Ann Neurol
. 2020 Jun 7.
doi: 10.1002/ana.25807. Online ahead of print.
COVID-19: A Global Threat to the Nervous System
Igor J Koralnik 1 , Kenneth L Tyler 2
Affiliations
- PMID: 32506549
- DOI: 10.1002/ana.25807
Abstract
In less than 6 months, the severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID-19) also involves multiple other organs including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS-CoV-2 infection is rapidly accumulating. These may result from a variety of mechanisms including virus-induced hyper-inflammatory and hypercoagulable states, direct virus infection of the CNS, and post-infectious immune mediated processes. Example of COVID-19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis and endothelialitis. In the peripheral nervous system COVID-19 is associated with dysfunction of smell and taste, muscle injury, the Guillain-Barre syndrome and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID-19 poses a global threat to the entire nervous system. While our understanding of SARS-CoV-2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID-19.