- Cerebrospinal fluid (CSF) (SARS/MERS)
- Olfactory bulb (SARS)
- Piriform and infra-limbic cortices (SARS)
- Ventral pallidum and lateral preoptic regions of the basal ganglia (SARS)
- Dorsal raphe (SARS)

Boston University

Many of the known coronaviruses are neurotropic, meaning they are able to infect neuron cells.  If these observed trends carry over to SARS-CoV-2, they could help to elucidate how the CNS is affected by COVID-19.  Some of the key observations include:

- human coronavirus OC43 was shown to transmit itself to different neurons via axons in mice
- neuronal ACE2 expression in mice was found to be in different pre-autonomic regions of the brain which could explain why infected COVID-19 patients with dangerously low blood oxygen levels don't gasp for air
- SARS-CoV was found to infect regions of the brain that deal with cardiopulmonary regulation in human ACE2 knock-in mice
- SARS-CoV patient autopsies showed that the virus affected neurons more than any other kind of cell

Trends in Other Coronaviruses Affecting the CNS
 Relevant to COVID-19

Yavarpour-Bali, H. and Ghasemi-Kasman M. (2020). Update on neurological manifestations of COVID-19. https://www.sciencedirect.com/science/article/pii/S0024320520308146?casa_token=hvKXqw85fB8AAAAA:v7n0KOvse9WCuxFEko2YKF8ZeyYqvnpHVTFsZoUtmba6fAovMBiUmKsR3bjZGLfv9_2Zvg

Update on neurological manifestations of COVID-19

- Direct infection injury detected in tissue samples 
- Blood circulation pathway, entering the CNS through BBB
- Neuronal pathway (e.g. olfactory neuron transport) infecting sensory or motor nerve endings
- Hypoxia injury, damages caused by lack of oxygen circulation
- Immune injury-- systemic inflammatory response syndrome(SIRS)
- Affecting the ability of ACE2 enzyme to regulate blood pressure, damaging the BBB

Mechanisms of CoV infections on the nervous system damage

Areas of the CNS Where Other CoV Antigens Have Been Detected

Patients who have recovered from SARS-Cov-1 demonstrate higher risks of developing Parkinson’s disease and multiple sclerosis. 31-50 months after the acute SARS-Cov-1 infection, Troyer et. al found evidence for post-traumatic stress disorder (39%), depression (36.4%), obsessive convulsive disorder (15.6%), and panic disorders (15.6%).


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