key: cord-0702488-iyxjpbly
authors: Baig, Abdul Mannan
title: Neurological manifestations in COVID‐19 caused by SARS‐CoV‐2
date: 2020-04-07
journal: CNS Neurosci Ther
DOI: 10.1111/cns.13372
sha: a1af9d390b9f8e2df4fc3fed999f2c0b897b70a2
doc_id: 702488
cord_uid: iyxjpbly

nan

The recent outbreak of COVID-19 caused by SARS-CoV-2 coronavirus has turned the world into chaos with its ominously high rate of transmissions. As the SARS-CoV-2 infection has become pandemic, the scientific community is in a race against time to beat the COVID-19 by unraveling molecular targets and discover epitopes in the protein sequences of SARS-CoV-2 for vaccines/antibodies synthesis. It has been reported that in addition to the conventional respiratory complains of flu, patients are also exhibiting neurological signs and symptoms. Recently, the report of a patient with COVID-19 exhibiting loss of the involuntary process of breathing 1 controlled by the inspiratory area in the brainstem, is alarming. Additionally, neurological deficits reported in uncomplicated and complicated patients with COVID-19 2 from hospitals in Wuhan, China, are convincing enough that the neurological deficits could be ongoing in the recent outbreak without getting noticed. As the recent outbreak has now spread to almost all of the continents and has become pandemic, we are in the early phases of our attempts to understand the syndromic complexity of the COVID-19. The SARS-CoV-2 causing COVID-19 can take two pathways to involve the brain ( Figure 1 ). Early occurrences of loss of smell, ataxia, and convulsions should be further evaluated for CNS involvement by SARS-CoV-2.

The clinicians throughout the world in general, and Wuhan, China, in particular, are getting the firsthand to study and report the real-time clinical presentations of the patients affected by COVID-19. The prognostic and diagnostic significance of neurological sign and symptoms in COVID-19 patients can be gauged by fact that the protocol designed to investigate the First Few X cases (FFX) and their close contacts by the World Health Organization (WHO), includes a separate section for "other neurological signs" in addition to separate columns for respiratory symptoms. 3 Additionally, reports of COVID-19-affected individuals experiencing convulsions in prevalent areas is alarming and need to be distinguished from febrile convolution that is expected to occur with high-grade fever in patients with COVID-19.

Our experience with taxonomically related SARS-CoV patients in the past has proven beyond doubt the coronaviruses to affect the brain. Of many examples from the past, was a case where SARS-CoV was isolated from the brain of a patient who had exhibited features of neurological deficits on 28th day of infection. 4 In past outbreaks with SARS-CoV, it has been shown that it targets the CNS 5 

The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients

Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study

The World Health Organization (WHO) The First Few X (FFX) Cases and contact investigation protocol for 2019-novel coronavirus (2019-nCoV) infection. WHO REFERENCE NUMBER: WHO/2019-nCoV/FFXprotocol/2020.2 CC BY-NC-SA 3.0 IGO

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