Fiani Brian, Covarrubias Claudia, Desai Aditi, Sekhon Manraj, Jarrah Ryan
Desert Regional Medical Center, Palm Springs, CA, United States.
Universidad Anáhuac Querétaro, Santiago de Querétaro, Querétaro, Mexico.
Front Neurol. 2020 Jun 23;11:640. doi: 10.3389/fneur.2020.00640. eCollection 2020.
Coronavirus 2019 (COVID-19) is currently the center of what has become a public health crisis. While the virus is well-known for its trademark effects on respiratory function, neurological damage has been reported to affect a considerable proportion of severe cases. To characterize the neuro-invasive potential of this disease, a contemporary review of COVID-19 and its neurological sequelae was conducted using the limited, but growing, literature that is available. These neurological squeal are based on the manifestations that the virus has on normal central and peripheral nervous system function. The authors present the virology of the SARS-CoV-2 agent by analyzing its classification as an enveloped, positive-stranded RNA virus. A comprehensive timeline is then presented, indicating the progression of the disease as a public health threat. Furthermore, underlying chronic neurological conditions potentially lead to more adverse cases of COVID-19. SARS-CoV-2 may reach ACE2 receptors on neuronal tissue through mode of the general circulation. The CNS may also be susceptible to an immune response where a "cytokine storm" can manifest into neural injury. Histological evidence is provided, while symptoms such as headache and vertigo are highlighted as CNS manifestations of COVID-19. Treatment of these symptoms is addressed with paracetamol being recommended as a possible, but not conclusive, treatment to some CNS symptoms. The authors then discuss the peripheral nervous system sequelae and COVID's impact on causing chemosensory dysfunction starting with viral attack on olfactory sensory neurons and cells types within the lining of the nose. Histological evidence is also provided while symptoms such as anosmia and ageusia are characterized as PNS manifestations. Possible treatment options for these symptoms are then addressed as a major limitation, as anecdotal, and not conclusive evidence can be made. Finally, preventive measures of the neurological sequelae are addressed using a multidirectional approach. Postmortem examinations of the brains of COVID-19 patients are suggested as being a possible key to formulating new understandings of its neuropathology. Lastly, the authors suggest a more comprehensive neurological follow-up of recovered patients, in order to better characterize the neurological sequelae of this illness.
2019冠状病毒病（COVID-19）目前已成为公共卫生危机的焦点。虽然该病毒以其对呼吸功能的标志性影响而闻名，但据报道，神经损伤在相当一部分重症病例中出现。为了描述这种疾病的神经侵袭潜力，我们利用现有的有限但不断增加的文献，对COVID-19及其神经后遗症进行了当代综述。这些神经后遗症是基于病毒对正常中枢和外周神经系统功能的影响表现。作者通过分析严重急性呼吸综合征冠状病毒2（SARS-CoV-2）作为一种包膜正链RNA病毒的分类，介绍了该病毒的病毒学。随后给出了一个全面的时间线，表明了该疾病作为公共卫生威胁的发展进程。此外，潜在的慢性神经疾病可能导致更严重的COVID-19病例。SARS-CoV-2可能通过体循环途径到达神经组织上的血管紧张素转换酶2（ACE2）受体。中枢神经系统也可能易受免疫反应影响，“细胞因子风暴”可能导致神经损伤。文中提供了组织学证据，同时强调头痛和眩晕等症状是COVID-19的中枢神经系统表现。对这些症状的治疗进行了探讨，对乙酰氨基酚被推荐作为治疗某些中枢神经系统症状的一种可能但不确定的药物。作者接着讨论了外周神经系统后遗症以及COVID-19对引起化学感觉功能障碍的影响，首先是病毒对嗅觉感觉神经元和鼻黏膜内细胞类型的攻击。文中也提供了组织学证据，同时嗅觉丧失和味觉丧失等症状被描述为外周神经系统表现。针对这些症状可能的治疗选择也进行了探讨，这是一个主要的局限，因为只能提供轶事证据而非确凿证据。最后，采用多方向方法探讨了神经后遗症的预防措施。建议对COVID-19患者的大脑进行尸检，这可能是形成对其神经病理学新认识的关键。最后，作者建议对康复患者进行更全面的神经学随访，以便更好地描述这种疾病的神经后遗症。
