key: cord-0761980-dd8z5c6d
authors: Mishra, Rakesh; Florez, William A.; Vasquez, Harold E.; Moscote-Salazar, Luis Rafael; Agrawal, Amit
title: SARS-CoV 2 and the Pathobiology of the Respiratory Control Mechanisms in the Brainstem
date: 2020-07-30
journal: J Formos Med Assoc
DOI: 10.1016/j.jfma.2020.07.035
sha: d675d541c71226956297d7f5d50d56a58236e4fa
doc_id: 761980
cord_uid: dd8z5c6d

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Respiratory function and its multiple implicated mechanisms have the objective to control pressures of carbon dioxide and oxygen, and adequate homeostasis by control of the concentration of hydrogen emissions. The neural role of respiratory physiology is important to maintin the said functioning. Interestingly, two sets of neuronal networks present within the brainstem is crucial for the generation of respiratory rhythm. 1 Literature suggests that neurotropism is one of the common features of coronaviruses. It is prudent to identify if SARS CoV-2 affects the respiratory control mechanisms at the brainstem and lead to complications in addition to primary respiratory damage. 2 SARS-CoV-2 can enter the brain directly via the cribriform plate or the hematogenous route. 3, 4 Studies indicate that SARS-CoV probably enters the brain through olfactory bulb and spread to thalamus and brainstem. 5 There are reports which suggest that involvement of pontine and medullary centres by SARS-CoV-2 is a mechanism implicated in potential central respiratory failure complicating primary pulmonary injury. 2 Interestingly, 62.4% of severe cases of SARS-CoV-2 do not present with dyspnea. 6 Since dyspnea is the perception of shortness of breath, this could be due to damage of sensory afferents in brain stem carrying signals from peripheral receptors. Recently a case report published illustrated brainstem dysfunction due to rhombencephalitis in a patient with acute COVID-19. 6 The use of preclinical models will be especially useful to understand the pathobiology of the coronavirus in the brain stem. 7 Therefore, patients with SARS-CoV-2 with neurological symptoms must be followed up closely as they can have further deterioration in their respiratory function. 8 It is also important to find the way SARS-CoV-2 invade the brain, i.e. direct, indirect, vascular or through peripheral nerves. 9 We propose the use of a neuroimaging protocol as soon as possible after the removal of mechanical ventilation to characterize the injury at the level of neural structures. Further insight can be obtained in these questions by using other neurological investigations and studies on neural architecture in autopsy studies.

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