key: cord-1050408-nd52wykh
authors: Bösel, Julian
title: Critical care physicians treating COVID-19: mind the nervous system!
date: 2020-06-08
journal: Crit Care
DOI: 10.1186/s13054-020-03026-x
sha: f90fb73e50c8eb3cc35f9f6ec4ab3c4982da6e3e
doc_id: 1050408
cord_uid: nd52wykh

nan

Pathophysiologically, the routes of neuroinvasion may be trans-synaptically, e.g., via cranial nerves connecting the (naso) pharynx and pulmonary organs with the central nervous system. Another very likely route is via the blood and endothelial cells at the blood-brain barrier. Also, lymphatic and enteric ports of entry are being discussed. Thereafter, cell entry of the virus works via ACE2, which is expressed by not only cells of the respiratory tract, but also endothelial cells, neurons, and glia.

At present, the rate and relevance of neurologic affection in COVID-19 critically ill patients are unclear, with studies on neurologic aspects just being started. However, these first observations should alarm intensivists all over the world, as additional damage to the brain and nerves will further impact on prognosis. Some supporting therapies may even end up detrimental if these comorbidities go unnoticed. But the latter will invariably happen if those are not actively looked for. Hence, intensivists of all disciplines should employ a low threshold of suspicion for nervous system involvement when treating COVID-19 in the ICU. Neurologic consults, neurocritical care expertise, brain imaging, lumbar puncture, and brain autopsy may all be warranted more often than we think.

Yours sincerely, Julian Bösel FNCS, FESO, President-elect German Society for Neurologic Intensive Care and Emergency Medicine (DGNI) 

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

Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)

Neurologic features in severe SARS-CoV-2 infection

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The author declares he has no competing interest with this letter.Received: 14 May 2020 Accepted: 25 May 2020