SARS-CoV-2, a coronavirus (CoV), is known to cause acute respiratory distress syndrome, and a number of non-respiratory complications, particularly in older male patients with prior health conditions, such as obesity, diabetes and hypertension. These prior health conditions are associated with vascular dysfunction, and the CoV disease 2019 (COVID-19) complications include multiorgan failure and neurological problems. While the main route of entry into the body is inhalation, this virus has been found in many tissues, including the choroid plexus and meningeal vessels, and in neurons and CSF. We reviewed SARS-CoV-2/COVID-19, ACE2 distribution and beneficial effects, the CNS vascular barriers, possible mechanisms by which the virus enters the brain, outlined prior health conditions (obesity, hypertension and diabetes), neurological COVID-19 manifestation and the aging cerebrovascualture. The overall aim is to provide the general reader with a breadth of information on this type of virus and the wide distribution of its main receptor so as to better understand the significance of neurological complications, uniqueness of the brain, and the pre-existing medical conditions that affect brain. The main issue is that there is no sound evidence for large flux of SARS-CoV-2 into brain, at present, compared to its invasion of the inhalation pathways. While SARS-CoV-2 is detected in brains from severely infected patients, it is unclear on how it gets there. There is no sound evidence of SARS-CoV-2 flux into brain to significantly contribute to the overall outcomes once the respiratory system is invaded by the virus. The consensus, based on the normal route of infection and presence of SARS-CoV-2 in severely infected patients, is that the olfactory mucosa is a possible route into brain. Studies are needed to demonstrate flux of SARS-CoV-2 into brain, and its replication in the parenchyma to demonstrate neuroinvasion. It is possible that the neurological manifestations of COVID-19 are a consequence of mainly cardio-respiratory distress and multiorgan failure. Understanding potential SARS-CoV-2 neuroinvasion pathways could help to better define the non-respiratory neurological manifestation of COVID-19.

中文翻译：

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SARS-CoV-2：有神经侵袭吗？


SARS-CoV-2 是一种冠状病毒 (CoV)，已知会引起急性呼吸窘迫综合征和许多非呼吸系统并发症，特别是对于患有肥胖、糖尿病和高血压等既往健康状况的老年男性患者。这些既往健康状况与血管功能障碍有关，2019 年冠状病毒病 (COVID-19) 并发症包括多器官衰竭和神经系统问题。虽然进入人体的主要途径是吸入，但这种病毒已在许多组织中发现，包括脉络丛和脑膜血管以及神经元和脑脊液。我们回顾了 SARS-CoV-2/COVID-19、ACE2 分布和有益影响、中枢神经系统血管屏障、病毒进入大脑的可能机制、概述了既往健康状况（肥胖、高血压和糖尿病）、神经学 COVID-19 表现以及脑血管的老化。总体目标是为普通读者提供有关此类病毒及其主要受体的广泛分布的广泛信息，以便更好地了解神经并发症的重要性、大脑的独特性以及先前存在的医疗状况影响大脑。主要问题是，与吸入途径的入侵相比，目前没有可靠的证据表明 SARS-CoV-2 大量流入大脑。虽然在严重感染患者的大脑中检测到 SARS-CoV-2，但尚不清楚它是如何到达那里的。没有可靠的证据表明，一旦呼吸系统被病毒入侵，SARS-CoV-2 流入大脑会对总体结果产生显着影响。 基于正常的感染途径和严重感染患者中 SARS-CoV-2 的存在，一致认为嗅粘膜是进入大脑的可能途径。需要进行研究来证明 SARS-CoV-2 进入大脑的流量及其在实质中的复制，以证明神经侵袭。 COVID-19 的神经系统表现可能主要是心肺窘迫和多器官衰竭的结果。了解潜在的 SARS-CoV-2 神经侵袭途​​径有助于更好地定义 COVID-19 的非呼吸神经系统表现。