Fig. 1.

Direct invasion of the hypothalamus or the medulla by SARS-CoV-2 through the neuronal or hematogenous routes can induce autonomic dysfunction. At the level of the hypothalamus, PVN plasticity may be modulated directly or indirectly by targeting GABAergic or glutamatergic interneurons. These interneurons synapse with the CRH neurons that connect to the pituitary gland. Inflammatory signals can also be translated into stress signals that overwhelm the PVN resulting in neuroinflammation and autonomic disruption. At the level of the medulla, viral invasion of GABAergic interneurons and astrocytes in the NTS can modulate normal autonomic function and/or cause cell death. Abbreviations: PVN: Paraventricular Nuclei; CRH: Corticotropin Releasing Hormone; NTS: nucleus tractus solitarius.