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50 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 2 0 NEUROLOGICAL PROBLEMS SARS-CoV-2 affects neurological function for many patients, but we are still figuring out all the ways this can happen. Not surprisingly, patients with severe CNS complications related to the virus also have a poorer prognosis for recovery compared to those without major CNS involvement. Some reports suggest the virus can attach to olfactory nerve endings in the nasal sinuses and travel to the CNS via axonal transport. ACE-2 receptors have been found on glial cells and within the cerebral blood vessels. Damage here may break down the blood-brain barrier that normally shields the CNS from pathogenic invasion. In some cases, viral particles have been found in cerebrospinal fluid, even while the standard diagnostic tests were negative. Early COVID-19 symptoms for some patients include the loss of smell and taste, possibly for several months, and these suggest sensory nerve impairment. Some people report numbness, tingling, or other types of paresthesia in various areas after their infection has peaked, which also indicates that the virus may have a direct and lingering effect on sensory nerves. Specific brain and brainstem problems may develop as well. Factors may include a direct viral attack on nerve or glial tissue, or cerebral hypertension from an extreme immune response and inflammation. This is essentially a form of encephalitis, and it can depress the respiratory drive, creating a vicious cycle of poor oxygen saturation and further difficulties with breathing. In addition, pressure and inflammation inside the CNS can cause dizziness, nausea, vomiting, headaches, and seizures. We see that many COVID-19 survivors are vulnerable to ischemic or hemorrhagic strokes related to coagulopathy, and this may occur in people much younger than those usually at risk. COVID-related strokes can cause permanent CNS damage and require a long rehabilitation process that may or may not be completely successful.