SARS-CoV-2 has been reported to exert toxic effects on multiple tissues and organs, such as lung, heart, esophagus, kidney, bladder, ileum, as well as the central nervous system (CNS). According to a study in Wuhan, dizziness (16.8%) and headache (13.1%) are the most common CNS symptoms, followed by impaired consciousness (7.5%), acute cerebrovascular disease (2.8%), ataxia (0.5%), and seizures (0.5%) [3]. In another study outside of Wuhan, the incidence of headache even reaches up to 34% [4]. Although there’s no direct evidence supporting a specific relationship between SARS-CoV-2 and human neuropathology, a spectrum of central neurological manifestations of COVID-19 have already been described in case reports and retrospective studies, including encephalitis, meningitis, encephalopathy, acute disseminated encephalomyelitis (ADEM), and acute cerebrovascular disease. The corresponding neuropathologic changes are also observed in the COVID-19 patients at autopsy [5–9] (Table 1).
Table 1 Neurological manifestations and associated neuropathological findings in COVID-19 patients
Manifestations Presentations Neuropathological findings Type of study References
Encephalitis/meningitis Three out of six patients presented with somnolent Cerebral cortex encephalitis with perivascular and parenchymal inflammatory infiltrates, and shrunken neurons Correspondence [5]
Encephalopathy Four out of 18 patients presented with myalgia, headache, and decreased taste, progressed to consciousness and multiorgan failure Hypoxic changes with no specific pathology Retrospective study [6]
Acute disseminated encephalomyelitis Fatigue and exertional dyspnea, progressed to shock state, respiratory failure Features resembling both vascular and demyelinating aetiologies among with range of sub-cortical white matter pathology Case report [7]
Acute cerebrovascular disease 17 patients presented with cerebral ischaemia, five with intracerebral haemorrhage and one with leukoencephalopathy of posterior reversible encephalopathy Thrombotic microangiopathy and endothelial injury Retrospective study [8]
Two patient presented with coma and multiorgan failure Microthrombi and acute infarcts Correspondence [9]