Evaluating the evidence for direct central nervous system invasion in patients
infected with the nCOVID-19 virus
#MMPMID32835019
Lekgwara P
; Kelly A
Interdiscip Neurosurg
2020[Dec]; 22
(?): 100829
PMID32835019
show ga
The current nCOVID-19 pandemic is raising several questions in the approximately
25% of patients who present with neurological symptoms. While secondary brain
injury from the systemic manifestations of the disease account for the majority
of non-specific neurological symptoms that include headache, nausea, and
progressive confusion, the question that remains unanswered is does the nCOVID-19
virus use the olfactory mucosa as a portal to directly invade the brain? A second
question is how common does direct CNS invasion complicate the classical
cardiorespiratory severe form of the disease? We know from previous studies that
almost all members of the Corona virus family have neurotropism. We also know
from the current pandemic that deteriorating consciousness and cerebrovascular
accidents are not uncommon. Several previous scattered case reports, and
post-mortem examinations of brain tissue, demonstrated nCOVID-19 nucleic acid in
the CSF, and brain tissue, of infected and deceased individuals. We performed a
PubMed review of the literature to specifically assess the evidence for the
direct CNS invasion by the nCOVID-19 virus. This phenomenon would explain the
cerebral oedema and encephalitis, that does occur, and bring Neurosurgeons into
the management of these patients by for example directed intra-cranial pressure
management post insertion of an intra-cranial pressure monitor. Unfortunately,
the answers to these questions were not definitively answered by the research
reviewed. While suggestive that direct CNS invasion does occur, the exact scale
and manifestations of the problem remains, to date, essentially unknown.
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