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2020 Aug 21

Pol Arch Intern Med

Neurological symptoms as a clinical manifestation of COVID-19: implications for internists.


Adamczyk-Sowa M, Niedziela N, Kubicka-Bączyk K, Wierzbicki K, Jaroszewicz J, Sowa P
Pol Arch Intern Med. 2020 Aug 21.
PMID: 32820884.


Many experimental and clinical studies have proven that the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has tropism to 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 (ACE2) receptors or by endocytosis. The infection of the central nervous system (CNS) with the systemic inflammation associated with Coronavirus Disease 2019 (COVID-19) 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 damaged, which results in respiratory distress. Apart from typical symptoms of COVID-19 related to the involvement of the respiratory system, neurological manifestations such as headache, dizziness, myalgia, anosmia, ageusia, encephalopathy, encephalitis, stroke, epileptic seizures, rhabdomyolysis and the Guillain-Barre syndrome (GBS) are associated with SARS-CoV-2 infection. In the study, attention was paid to the currently known neurological manifestations of COVID-19 so that they could be considered mainly in COVID-19 asymptomatic patients, which may limit the transmission of coronavirus infection.