Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus
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,...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Interdisciplinary Neurosurgery |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S221475192030390X |
| _version_ | 1818609995991744512 |
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| author | Patrick Lekgwara Adrian Kelly |
| author_facet | Patrick Lekgwara Adrian Kelly |
| author_sort | Patrick Lekgwara |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-16T15:07:24Z |
| format | Article |
| id | doaj.art-12fb4f25f31046c2967211b1ef0b1192 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-16T15:07:24Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-12fb4f25f31046c2967211b1ef0b11922022-12-21T22:27:03ZengElsevierInterdisciplinary Neurosurgery2214-75192020-12-0122100829Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virusPatrick Lekgwara0Adrian Kelly1Department of Neurosurgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South AfricaCorresponding author at: P.O Box Medunsa, Pretoria, South Africa.; Department of Neurosurgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South AfricaThe 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.http://www.sciencedirect.com/science/article/pii/S221475192030390X |
| spellingShingle | Patrick Lekgwara Adrian Kelly Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus Interdisciplinary Neurosurgery |
| title | Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus |
| title_full | Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus |
| title_fullStr | Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus |
| title_full_unstemmed | Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus |
| title_short | Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus |
| title_sort | evaluating the evidence for direct central nervous system invasion in patients infected with the ncovid 19 virus |
| url | http://www.sciencedirect.com/science/article/pii/S221475192030390X |
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