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Possible pathways of SARS-CoV-2 pathogenesis causing neurological manifestations. SARS-CoV-2 may travel through an upper nasal transcribial route involving the olfactory bulb, binding to ACE2 receptors in the nasopharynx and brain and causing cytokine storm via activation of macrophages, microglia, and astrocytes. Alternatively, systemic infection and inflammation by SARS-CoV-2 can also lead to CNS and PNS manifestations if the blood–brain barrier is compromised.
