Listed in Issue 279


KORALNIK and COLLEAGUES, •   1 Davee  Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 2 Department of Neurology, Medicine, and Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA review SARS-CoV-2 neuropathogenesis to provide a useful framework and help neurologists in understanding the many neurologic facets of COVID-19.


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 hyperinflammatory and hypercoagulable states, direct virus infection of the central nervous system (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. Although 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. © 2020 American Neurological Association.


Igor J Koralnik  1 , Kenneth L Tyler  2. COVID-19: A Global Threat to the Nervous System Ann Neurol; 88(1):1-11. doi: 10.1002/ana.25807.  Jul 2020.

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