Human coronaviruses are highly pathogenic viruses that pose a serious threat to human health. Examples include the severe acute respiratory syndrome outbreak of 2003 (SARS-CoV-1), the Middle East Respiratory Syndrome (MERS-CoV) outbreak of 2012, and the current SARS-CoV-2 (COVID-19) pandemic. Herein, we review the neurological manifestations of coronaviruses and discuss the potential pathogenic role of blood–brain barrier dysfunction. We present the hypothesis that pre-existing vascular damage (due to aging, cardiovascular disease, diabetes, hypertension or other conditions) facilitates infiltration of the virus into the central nervous system (CNS), increasing neuro-inflammation and the likelihood of neurological symptoms. We also discuss the role of a neuroinflammatory cytokine profile in both blood–brain barrier dysfunction and macrovascular disease (e.g. ischemic stroke and thromboembolism). Future studies are needed to better understand the involvement of the microvasculature in coronavirus neuropathology, and to test the diagnostic potential of minimally-invasive screening tools (e.g. serum biomarkers, fluorescein retinal angiography and dynamic-contrast MRI).

中文翻译：

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微血管病理学在冠状病毒感染神经学表现中的潜在作用


人类冠状病毒是高致病性病毒，对人类健康构成严重威胁。例如，2003 年爆发的严重急性呼吸综合征 (SARS-CoV-1)、2012 年爆发的中东呼吸综合征 (MERS-CoV) 以及当前的 SARS-CoV-2 (COVID-19) 大流行。在此，我们回顾了冠状病毒的神经学表现，并讨论了血脑屏障功能障碍的潜在致病作用。我们提出的假设是，预先存在的血管损伤（由于衰老、心血管疾病、糖尿病、高血压或其他疾病）会促进病毒渗入中枢神经系统（CNS），增加神经炎症和神经系统症状的可能性。我们还讨论了神经炎症细胞因子谱在血脑屏障功能障碍和大血管疾病（例如缺血性中风和血栓栓塞）中的作用。未来的研究需要更好地了解微血管系统在冠状病毒神经病理学中的参与，并测试微创筛查工具（例如血清生物标志物、荧光素视网膜血管造影和动态对比 MRI）的诊断潜力。