Since the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a growing body of evidence indicates that besides common COVID-19 symptoms, patients may develop various neurological manifestations affecting both the central and peripheral nervous systems as well as skeletal muscles. These manifestations can occur prior, during and even after the onset of COVID-19 general symptoms. In this Review, we discuss the possible neuroimmunological mechanisms underlying the nervous system and skeletal muscle involvement, and viral triggered neuroimmunological conditions associated with SARS-CoV-2, as well as therapeutic approaches that have been considered for these specific complications worldwide. Highlights • Patients with coronavirus disease 2019 (COVID-19) may variably develop neurological manifestations. • Neuroinflammation and autoimmunity may underlie COVID-19 neurological complications. • COVID-19 neuroimmunological complications include Guillain-Barré syndromes, myopathy, and encephalomyelitis. • Immunotherapy may variably improve outcome in COVID-19 related neuroimmunological complications.
【저자키워드】 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Encephalitis, Coronavirus disease 2019 (COVID-19), Myelitis, interleukin, IL, Coronavirus disease 2019, COVID-19, Neuroimmunity, Guillain-Barré syndromes, angiotensin-converting enzyme 2, ACE-2, acute disseminated encephalomyelitis, ADEM, anti-epileptic drugs, AEDs, acute inflammatory demyelinating polyneuropathy;, AIDP, acute motor axonal neuropathy, AMAN, acute motor and sensory axonal neuropathy, AMSAN, acute necrotizing encephalopathy, ANE, activated partial thromboplastin time, aPTT, aquaporin-4, AQ4, acute respiratory distress syndrome, ARDS, blood-brain barrier;, BBB, creatinine kinase, CK, central nervous system, CNS, C-reactive protein, CRP, cytokine release syndrome, CRS, cerebrospinal fluid, CSF, dipeptidyl peptidase 4, DPP4, diffusion-weighted imaging, DWI, electroencephalography, EEG, electromyography/nerve conduction study, EMG/NCS, erythrocyte sedimentation rate, ESR, fluid attenuated inversion recovery, FLAIR, Guillain-Barré syndrome, GBS, granulocyte-macrophage colony stimulating factor, GMCSF, hemagglutinating encephalomyelitis virus, HEV, intensive care unit, ICU, intravenous immunoglobulin, IVIG, olfactory receptor neurons, ORN, olfactory endothelia, OE, macrophage activation like syndrome, MAL, Middle East respiratory syndrome, MERS, Miller-Fisher syndrome, MFS, myelin oligodendrocyte glycoprotein, MOG, mouse hepatitis virus, MHV, nuclear factor κ-light-chain-enhancer of activated B cells, NF-κB, peripheral nervous system, PNS, personal protective equipment, PPE, prothrombin time, PT, real-time reverse transcription polymerase chain reaction, rRT-PCR, severe acute respiratory syndrome, SARS, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, secondary hemophagocytic lymphohistiocytosis, sHLH, single-stranded RNA, ss-RNA, toll-like receptors, TLRs, transmembrane protease, serine 2, TMPRSS2, tumor necrosis factor-α, TNF-α, TNF receptor-associated factor 6, TRAF6, TIR-domain-containing adapter-inducing interferon-β, TRIF, white blood cell, WBC, World Health Organization, WHO,