Intro: COVID-19 has been associated with neurological manifestations such as headaches, insomnia, and strokes. However, it is unclear if COVID-19 directly attacks the CNS or if it is the body’s response to the virus. Experiments were conducted to address this issue.
Study:  by the New England Journal of Medicine in Boston, MA. 
Sample: 18 patients who died at a single teaching hospital from April 14, 2020, to April 29, 2020. All patients were positive for SARS-CoV-2. Fourteen out of eighteen (14/18) patients were males. Neurologic symptoms include myalgia (n=3), headaches (n=2), and decreased sense of taste (n=1). Comorbidities include Diabetes Mellitus (n=12), hypertension (n=11), cardiovascular disease (n=5), hyperlipidemia (n=5), chronic kidney disease (n=4), prior stroke (n=4), dementia (n=4), and treated anaplastic astrocytoma (n=1). Eleven patients were placed on mechanical ventilation. 
Method: Used Neuropathological methods that combine immunochemistry techniques, Reverse transcriptase PCR (RT-qPCR) to examine postmortem tissue. 
Results: 
Neuropathological analysis of brain tissue showed hypoxic injury in the cerebellum in all patients. 
The analysis also showed the loss of neurons in the cerebral cortex, hippocampus, and cerebral Purkinje cell layer. 
There were no thrombi or vasculitis detected in these areas. However, immunochemistry and RT-qPCR showed minimal traces of SARS-CoV-2 in the brain.
There were two rate foci of perivascular lymphocytes detected in n=2 brains.  
Focal leptomeningeal inflammation was detected in n=1 of the brains. 
The study concluded that hypoxic changes in the brain are attributed to patient-specific comorbidities or secondary effects of the virus. 


Neuropathological Features of Covid-19

Florida State University

The effects of COVID-19 on the nervous system and the human brain.

Neurological impacts and neuroscience (neurobiology) of COVID-19

Neuroscience specific papers
- Journal of Clinical Neuroscience
- The Lancet Psychiatry
- Nature (journal of Neurobiology)
- The New England Journal of Medicine 

References for Neuroscience of COVID-19

Molecular Neuroscience 

Computational Neuroscience 

- COVID-19 patients often present neurological problems, such as anosmia, headache, dysgeusia altered mental status (AMS), Guillen-Barre Syndrome, or ischemic stroke. 
- Researchers analyzed the medical records of COVID-19 patients in Louisiana, in which 80% of the sample was African American, to assess neurological complications from COVID-19.  It was found that 14% of the sample presented with a neurological chief complaint at presentation, with the most common complaints being either AMS, syncope, or headache.  Upon hospitalization, 38% of the sample had a neurological complication, with AMS being the most common complication present.  

Neurological Complications in a Predominantly African American Population of COVID-19 

Case Study to Show Effects

1. In this case study, meningoencephalitis was seen as a major clinical manifestation of COVID-19. In this report, a person with a history of type-2 diabetes presented with a low-grade fever of 100.5 ° F, headache, stiff neck, photophobia, seizure without respiratory distress. Anti-epileptic therapy was started for the management of viral meningitis.                                                                                                                                                        2. The localization of the virus in brain tissues was studied in mice infected with SARS-CoV34 and MERS-CoV13

Results:
1. The clinical progression demonstrated rapid clinical deterioration with disorientation and hallucinations. SARS-CoV-2 detection tests were positive, and she was treated with hydroxychloroquine with improvement in symptoms during a clinical course of 5 days following admission to hospital. In a second case, a young man in his twenties presented total anosmia and ageusia with high suspicion of SARS-CoV-2 infection.                                                                                  
2. As cardio-respiratory impariments cause reflect brainstem dysfunction, it may be repsonsible for ARDS as it is a frequent cause of COVID-19. - Mouse hepatitis virus, porcine hemagglutinating encephalitis virus, feline CoV - Virus can cross epithelal cells

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