The new coronavirus of a heavy acute respiratory syndrome-2 (SARS-CoV-2), developed in the city of Wuhan, China, in December, 2019, having led to the heavy outbreak of pneumonia. The Koronavirusny disease of 2019 (COVID-19), and its pulmonary manifestations are well described. Patients have more and more certificates on neurologic complications and diseases with COVID-19. Two similar coronaviruses of the person (CoV), a Middle Eastern/respiratory syndrome (MERS-CoV) and a heavy acute respiratory syndrome (SARS-CoV-1), were also associated with neurologic diseases in rare instances. It brings up a question of whether SARS-CoV-2 is neurotropic and whether it contributes to the development of postinfectious neurologic complications. In a small number of case histories neurologic complications at patients with COVID-19 are described. Remains, however, to unknown in what degree of SARS-CoV-2 injures the central nervous system (CNS) and whether neurologic symptoms are connected with secondary mechanisms.
The SARS-CoV-2 virus has the sequence of a genome, close to SARS-CoV-1. Both viruses use the proteins thorns located on a surface for linking with a receptor of the angiotensin-converting enzyme 2 (ACE2) of cells of mammals, and then use serinovy protease, the membrane and connected serinovy protease 2 (TMPRSS2) to activate a thorn. Presence of receptors of APF2 at fabrics defines cellular tropism of a virus at people. At people APF2 expresses in an epithelium of respiratory tracts, cells of kidneys, a small bowel, a parenchyma of lungs and an endothelium of vessels on all organism and is extensive on all central nervous system. There is information on specific cellular and space localization in a brain of the person. The prevalence of an expression of APF2 in a brain causes concerns that SARS-CoV-2, SARS-CoV-1 is similar, has potential to infect neurons and glial cells on all central nervous system.
Though patients have messages about neurologic complications with COVID-19, remains not clear whether SARS-CoV-2 is neurotropic at people. Penetration of a virus, presumably, can happen in several ways, including transsinaptichesky transfer through the infected neurons, penetration through an olfactory nerve, infection of an endothelium of vessels or migration of leukocytes through a blood-brain barrier (GEB).
Information on neurologic manifestations at patients with COVID-19 is separate. Now there is only a small number of the published case histories and clinical trials. In the systematic research conducted to Wuhan, China it was reported about existence of neurologic manifestations at 214 patients hospitalized with COVID-19.59 B other systematic research conducted in France at 49 patients from 58 neurologic symptoms were noted, including confusion of consciousness, encephalopathy and signs of defeat of a cortical and spinal way at survey and also leptomeningeal accumulation of contrast and anomaly of perfusion at the magnetic resonance imaging (MRI).
The most common neurologic symptoms at COVID-19 are the headache, an anosmia and an ageusia. A stroke, disturbances of consciousness, a lump, a spasm and encephalopathy are among other found neurologic manifestations.
Key line of encephalopathy are disturbance of attention and excitement which is followed by confusion of consciousness, apathy, slackness, a delirium or a coma. The widespread risk factors contributing patients to a delirium are the old age, the cornerstone dementia or cognitive disturbances, multiple associated diseases, infections, serious illnesses, a bad functional state and improper feeding. Many metabolic and endocrine disturbances put patients at additional risk of development of encephalopathy, including, among other things, a hyponatremia or a hypernatremia, a hypocalcemia or a hypercalcemia, renal dysfunction, dysfunction of a liver and a hypoglycemia or a hyperglycemia. Sepsis and the subsequent inflammation and a tsitokinovy storm can also contribute to the development of encephalopathy because of IL-6, IL-8, IL-10 and a factor of a necrosis of a tumor α, involved in conditions of confusion of consciousness.
Besides, spasms can also lead to consciousness disturbance, and was reported about them at other CoV-infections. Besides, subclinical spasms are registered approximately at 10% of patients with deadly diseases and patients with primary convulsive frustration in the conditions of a heavy infection are exposed to higher risk of development of spasms and the epileptic status.
Also such serious manifestations of COVID-19 as a stroke were noted. The pathophysiology of the increased risk of development of cerebrovascular diseases during COVID-19 infection probably is multifactorial.
Besides, now there is a set of various drugs which are used for treatment of patients with COVID-19. A row from them can also render certain neurologic effects.