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Emergency Medical Minute


Apr 23, 2020

Accumulating clinical evidence suggests that many patients with COVID have neurological symptoms and that some may even present with neurologic manifestations of the disease. Most COVID patients have a cough, respiratory distress, and while clinicians often speak about how similar the presentations of patients with respiratory COVID are, it’s worth looking at the possibility that COVID has atypical presentations, too.There’s very good evidence that coronaviruses can infect all sorts of human cells--not just those in the respiratory tract. A few weeks ago we discussed ACE inhibitors and NSAIDs and SARS COV2 and you may remember that the virus attaches to the ACE2 receptor--a receptor which is found on a wide range of human cells. What are the chances the virus can infect a patients brain cells, cranial nerves, peripheral nerves?

Host: Elizabeth Esty, MD

Research By: Tanisha Crosby-Attipoe & Mason Tuttle

Sound Editing By: Stephen Bahmani

Time Stamps:

0:23 - Numbers

1:25 - Possible Neurological Manifestations of COVID

4:15 - What are the chances the virus can infect a patients brain cells, cranial nerves, peripheral nerves?

4:55 - The neuroinvasive potential of SARS‐CoV2 may play a role in the respiratory failure of COVID‐19 patients

8:24 - early neurological research from NEJM in February

9:10 - some early research indicated possible neurological manifestations

10:05 - COVID and serious CV incidents

10:40 - Italian Neurologists urge other nations to be alert for neuro presentations of COVID

11:11 - Case report in Radiology, COVID patient with encephalopathy

12:06 - Possible link with Guillain-Barré 


  1. Li Y-C, Bai W-Z, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. Journal of Medical Virology. 2020;92(6):552-555. doi:10.1002/jmv.25728
  2. Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features. Radiology. March 2020:201187. doi:10.1148/radiol.2020201187
  3. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. April 2020. doi:10.1001/jamaneurol.2020.1127
  4. Li Y, Wang M, Zhou Y, et al. Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study. Rochester, NY: Social Science Research Network; 2020. doi:10.2139/ssrn.3550025
  5. Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? The Lancet Neurology. 2020;19(5):383-384. doi:10.1016/S1474-4422(20)30109-5

Further reading and listening: