key: cord-0771137-7ktgyimu
authors: Ansari, Ahmed; Riyaz, Sadaf
title: Letter to the Editor: Transneural transmission in COVID-19 without a positive nasopharyngeal swab
date: 2020-09-12
journal: Surg Neurol Int
DOI: 10.25259/sni_335_2020
sha: b3cf5d6ff5697596c5c80bf8827885652b0728ba
doc_id: 771137
cord_uid: 7ktgyimu

nan

We read with great interest the article by Bamps et al. [1] on the need of urgent and semi-emergent neurosurgeries in the present scenario. However, we sincerely feel that all patients presenting in the outpatients and emergency be handled as a positive case. ere have been reported instances of a positive CSF for COVID in the absence of a positive nasopharyngeal swab. [2] 1. Brain infection in COVID-19 patients is being seriously considered recently, owing to multiple reports of stroke, epilepsy, and encephalitis. ACE-2 expression in glia and neurons of brain is low, but well documented. SARS-CoV-2 invading high ACE-2 expressing non-neuronal olfactory epithelial cells is one such possibility and then passing to low ACE-2 expressing mature olfactory receptor neurons to be finally transported along olfactory axons to the brain. e lateral stria of olfactory tract carries axons to the primary olfactory cortex, located in the uncus of the temporal lobe. is can be argued as an important reason for the inflammation in medial temporal cortex and hippocampus in such patients. 2. Although the first reported case of meningitis/encephalitis associated with CoV2 reports the use of antiviral drug laninamivir on the 2 nd day with a negative test, [2] it is very highly likely that the test missed the low viral load on the 2 nd day, because when the patient was admitted owing to loss of consciousness, there was small ground-glass opacity on the right superior lobe and both sides of inferior lobe of the lung, implying toward the infection earlier. It can be hypothesized that there is a small category of COVID patients, in whom the respiratory manifestation of Cov-2 is a minimum, concentrating mainly toward olfactory epithelium for viral transneural transmission.

Nevertheless, a more vigilant eye is required in this pandemic disease to have a better understanding of this entity.

Even with COVID-19 neurosurgeons should still perform necessary urgent/emergent neurosurgery to avoid major permanent neurological deficits

A first case of meningitis/encephalitis associated with SARS-Coronavirus-2

How to cite this article: Ansari A, Riyaz S. Letter to the Editor: Transneural transmission in COVID-19 without a positive nasopharyngeal swab

ere are no conflicts of interest.