Sign Up for a Free Account
  • Updated 01.23.2022
  • Released 04.10.2020
  • Expires For CME 01.23.2025

Neurologic complications of coronavirus infections


Coronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome. The word corona is derived from “crown,” which describes the spike-like proteins on its surface. They are classified as four genera: alpha, beta, gamma, and delta. The alpha, beta, and delta coronaviruses infect mammals, whereas delta and gamma coronaviruses infect avian species. However, the virus has the ability to jump between species, leading to the emergence of Middle East respiratory syndrome (MERS) caused by MERS-CoV, severe acute respiratory syndrome (SARS) caused by SARS-CoV-1, and COVID-19 caused by SARS-CoV-2, with deadly consequences (21). To date, seven human coronaviruses have been identified (Table 1). SARS and SARS-CoV-2 are thought to have originated from bats (06). They use the “spike proteins” to attach to angiotensin-converting enzyme receptor type 2 (ACE2), which is highly expressed in the respiratory tract. ACE2 receptors are also known to be expressed in both neurons and glia in several CNS areas, most notably in the choroid plexus and the thalamus. Several strains of SARS-CoV-2 have been identified. Currently, the most predominant strain is the delta strain. There does not appear to be any major difference in the neurotropism or neurovirulence between the various strains.

Table 1. Types of Human Coronaviruses and Their Receptors















ACE=angiotensin converting enzyme; DPP4=Dipeptidyl peptidase 4

The virus has four main structural proteins: Spike (S)-protein is a trimeric protein that mediates attachment to the host receptor and is made of two separate polypeptides called S1 (binding domain) and S2 (stalk). The membrane protein is the most abundant structural protein in the virion. The envelope protein facilitates assembly and release of the virus. The ion channel activity in SARS-CoV envelope protein plays a critical role in pathogenesis. The N-protein constitutes the nucleocapsid that binds the viral RNA. The hemagglutinin-esterase protein is present in a subset of beta-coronaviruses and binds sialic acids on surface glycoproteins and contains acetyl-esterase activity (21). The neuropathogenesis of coronaviruses has been best studied in a mouse model infected with the mouse hepatitis virus.

This is an article preview.
Start a Free Account
to access the full version.

  • Nearly 3,000 illustrations, including video clips of neurologic disorders.

  • Every article is reviewed by our esteemed Editorial Board for accuracy and currency.

  • Full spectrum of neurology in 1,200 comprehensive articles.

  • Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink®, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660



ISSN: 2831-9125