Review Article Open Access
Volume 3 | Issue 4 | DOI: https://doi.org/10.33696/immunology.3.107

Neurological Manifestations Associated with SARS-CoV-2 Invasion of the Autonomous Nervous System

  • 2Neuro-anesthesiology and Intensive Care Medicine, GHU-Psychiatrie et Neurosciences, Université de Paris, Paris, France
  • 1Laboratory for Perception and Memory, Institut Pasteur, CNRS UMR3571, 25, rue du Docteur Roux, Paris, 75724, Cedex 15,France
  • #These authors contributed equally
  • 3National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), and D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
+ Affiliations - Affiliations

Corresponding Author

Tarek Sharshar, t.sharshar@ghu-paris.fr

Received Date: May 11, 2021

Accepted Date: August 12, 2021


Although pneumonia and acute respiratory failure are the most frequent and severe complications of patients with SARS-CoV-2 infection, many of them also develop neurological signs and symptoms. From sickness behavior to coma, neurological disorders are associated with impairment of consciousness and dysautonomia, resulting from brainstem dysfunction. We propose here that SARS-CoV-2 invasion via the olfactory and trigeminal nerves generates a local neuro-inflammatory process aggravated by systemic inflammatory responses and micro-circulatory ischemic process. In addition to its short and long-term neurological consequences, the COVID-19-related brainstem dysfunction compromises the adaptive response to stress and contributes to organ failure and death. The detection of brainstem dysfunction mainly relies on neurological examination and non-invasive methods, such as pupillometer and spectral analyses of heart rate and blood pressure. We review the existing evidence of brainstem involvement in the course of Covid-19, its main mechanisms, diagnostic strategies, and potential outcomes.


Brainstem; Neurotropism; COVID-19; Nucleus Tractus Solitarius; Olfaction, Neuroinflammation

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