Table 1.
Representative cases of CNS infection with hCoVs
| hCoV | Age/Sex | Onset Symptoms | Neurological Symptoms/Signs | Chest Radiography | Brain CT/MRI | CSF | Other Special Tests | Outcome | Ref |
|---|---|---|---|---|---|---|---|---|---|
| SARS-CoV | 39/M | fever, chills, malaise, headache, dizziness, myalgia | obscured monocular vision (26) →dysphoria, vomiting, deliria (28) →coma (33) →brain herniation (35) | left lower lobe infiltrates (11) →obvious resolution (28) →progressive bibasilar infiltrations (35) | CT: broad encephalic pathological changes of probably ischemia and necrosis and brain edema (33) | none | Eye-ground exam: an exudation around the visual yellow zone (26) | Death (35) | [25] |
| SARS-CoV | 32/F | myalgia, fever, chills, rigor, unproductive cough (w26 of pregnancy) | generalized tonic-clonic convulsion with loss of consciousness and up-rolling eyeballs for 1 min (29) | Patchy consolidations over the right upper lobe and both lower lobes (7) | MRI: no abnormalities (53) | opening pressure of 15cm of water, clear, cultures (-), SARS-CoV by RT-PCR (+) (29) | Electroencephalogram: no abnormalities (46) | Recovery (34), pregnancy terminated by CS (15) | [28] |
| SARS-CoV | 59/F | swinging fever, chills, productive cough, diarrhea | vomiting, episodes of four-limb twitching, confused, disorientated →recurred and prolonged (>30min) seizures | CT: progressive bilateral consolidation | CT: no abnormalities | Normal opening pressure, clear, cultures (-), SARS-CoV by RT-PCR (+) | none | Recovery | [29] |
| MERS-CoV | 74/M | fever | ataxia, vomiting, confusion (0) / dysmetria, decreased motor power on the left side (3) →coma, GCS 3-4 (27) | infiltrate in the mid right lung zone (3) →progression in air space disease (10) | CT: multiple chronic lacunar strokes but no acute changes (3) →an interval development of numerous patchy and one large hypodensities (27) MRI: moderate chronic small vessel ischemic changes (8) →multiple bilateral patchy areas of signal abnormality (31) |
MERS-CoV by RT-PCR (-) | none | Death (37) | [30] |
| MERS-CoV | 57/M | flu-like illness, fever, diabetic foot | unresponsive, hypotensive with left-sided facial paralysis (7) | CT: two subtle hypodensities at right semiovale and left basal ganglia, likely small lacunar infarctions, near total occlusion at origin of internal carotid arteries with M1 narrowing of left MCA (7) CT: interval multiple patchy hypodensities. MRI: bilateral signal abnormalities consistent with acute infarction (11) |
none | none | Death (12) | [30] | |
| MERS-CoV | 45/M | productive cough, dyspnea, rigors, fever, diarrhea | Low GCS (34) | infiltrate in the lower and mid right zones (10) | CT: no acute abnormality (34) MRI: confluent T2W1/FLAIR hyperintensity within the white matter of both cerebral hemispheres and along the corticospinal tract (35) |
MERS-CoV by RT-PCR (-) | Recovery (117) | [30] | |
| MERS-CoV | 34/F | high-grade fever, generalized bone pain and fatigue | Severe headache, nausea, vomiting, GCS 3/15 (15) | right lung homogenous opacity | CT: right frontal lobe intracerebral hemorrhage with massive brain edema and midline shift (15) | Death (∼60) | [31] | ||
| MERS-CoV | 28/M | fever, generalized myalgia, dizziness, productive cough | Weakness in both legs and inability to walk with numbness and tingling in stocking distribution | MRI: normal | normal | NCV: length dependent axonal polyneuropathy | Recovery | [31] | |
| OC43 | 15/M | upper respiratory tract illness | numbness in the lower extremities, difficulty walking, clumsiness in right hand, increased irritability / mild distal weakness in the right hand and foot, patchy loss of vibration and temperature sensation below T10, mild dysmetria of the left hand, poor heel-to-toe walking, antalgic gait (7) | MRI: lesions on T2-weighted imaging at C4-C5 and at T7-T8. The spinal cord lesions were non-enhancing. Patchy areas of hyperintensity (7) →MRI: improvement of the lesions in the brain and cerebellum (∼42) →MRI: a possible new lesion in the left hemisphere of the cerebellum. The periventricular lesion in the right cerebral hemisphere appeared brighter and larger. The spinal cord lesions had resolved (90) | OC43 by RT-PCR (+) | Recovery | [13] | ||
| OC43 + 229E | 3/F | fever, rhinorrhea, cough, weakness | inability to walk / damaged swallowing, chewing and speech functions, muscle strength 0/5, absent deep tendon reflexes, flexor plantar response (1) | normal | MRI: no abnormalities | normal pressure, glucose and protein, culture (-) | EMG: no pathological findings. | Recovery | [15] |
All cases had fever and/or flu-like symptoms at the onset. Half of the patients (5/10) had headache, dizziness or vomiting as an early sign of neurological manifestation. 2/3 SARS patients had seizures, whereas 3/5 MERS patients and both OC43-infected cases had facial/limb paralysis. Unfortunately, MERS-CoV has not been detected in CSF samples of any of the reported cases. Ischaemic changes have been detected in images of half of the patients, while haemorrhagic pathology has been identified on one MERS patient. The OC43-related CNS-infected patients were younger compared to SARS and MERS patients. GCS: Glasgow Coma Scale; NCV: Nerve Conduct Velocity; EMG: Electroneuromyography.