COVID-19, SARS and MERS: A neurological perspective

Area of Science:

• Neurology
• Infectious Diseases
• Pathophysiology

Background:

• COVID-19 (Coronavirus disease 2019) predominantly causes acute respiratory infection, manifesting as pneumonia.
• Early observations in China identified neurological symptoms in a subset of COVID-19 patients, particularly those with severe disease.
• These neurological manifestations included impaired consciousness, skeletal muscle injury, and acute cerebrovascular disease.

Purpose of the Study:

• To review the historical association between severe acute respiratory syndrome-related coronavirus (SARS-CoV), Middle East respiratory syndrome-related coronavirus (MERS-CoV), and SARS-CoV-2 (the virus causing COVID-19) with neurological complications.
• To compare and contrast neurological outcomes observed during past coronavirus outbreaks (SARS, MERS) with those reported in the current COVID-19 pandemic.
• To discuss potential mechanisms underlying coronavirus-induced neurological impact and highlight neurology-specific considerations.

Main Methods:

• Literature review synthesizing findings from past coronavirus outbreaks (SARS, MERS) and the ongoing COVID-19 pandemic.
• Analysis of reported neurological symptoms and complications associated with these viral infections.
• Examination of proposed pathophysiological mechanisms linking coronaviruses to the nervous system.

Main Results:

• Coronaviruses, including SARS-CoV, MERS-CoV, and SARS-CoV-2, have been historically associated with a spectrum of neurological complications.
• Neurological symptoms in COVID-19 patients can range from altered consciousness to cerebrovascular events and myopathy.
• Evidence suggests varying frequencies and types of neurological involvement across different coronavirus outbreaks.

Conclusions:

• Neurological complications are a significant, though not universal, feature of infections caused by highly pathogenic coronaviruses like SARS-CoV-2.
• Understanding the historical context of SARS and MERS provides insights into potential neurological sequelae of COVID-19.
• Further research into the mechanisms of neuroinvasion and neuroinflammation is crucial for managing COVID-19's neurological impact.