Neurological symptoms in SARS-CoV-2-infected patients have been reported, but their cause remains unclear. In theory, the neurological symptoms observed after SARS-CoV-2 infection could be (1) directly caused by the virus infecting brain cells, (2) indirectly by our body’s local or systemic immune response toward the virus, (3) by coincidental phenomena, or (4) a combination of these factors. As indisputable evidence of intact and replicating SARS-CoV-2 particles in the central nervous system (CNS) is currently lacking, we suggest focusing on the host’s immune reaction when trying to understand the neurocognitive symptoms associated with SARS-CoV-2 infection. In this perspective, we discuss the possible immune-mediated mechanisms causing functional or structural CNS alterations during acute infection as well as in the post-infectious context. We also review the available literature on CNS affection in the context of COVID-19 infection, as well as observations from animal studies on the molecular pathways involved in sickness behavior.

SARS-CoV-2 感染患者的神经系统症状已有报道，但其原因尚不清楚。从理论上讲，SARS-CoV-2感染后观察到的神经系统症状可能是（1）病毒感染脑细胞直接引起的，（2）人体对病毒的局部或全身免疫反应间接引起的，（3）巧合现象，或 (4) 这些因素的组合。由于目前缺乏中枢神经系统 (CNS) 中完整和复制 SARS-CoV-2 颗粒的无可争辩的证据，我们建议在试图了解与 SARS-CoV-2 感染相关的神经认知症状时关注宿主的免疫反应。从这个角度来看，我们讨论了在急性感染期间以及感染后环境中导致功能或结构 CNS 改变的可能免疫介导机制。