THREAD
1/ I hope no one believes that I am an expert on #SARSCoV2 or believes that “I” think I am an expert on #COVID19

In an effort to contribute to the greater good of this #pandemic pandemic, I have been trying to utilize my clinical research experience and help remotely https://twitter.com/ErinSandersNP/status/1249236555962646528
2/ ...in lieu of actively seeing patients on the front line.

My role has been asking questions, synthesizing ideas, and hoping to catalyze discussion amongst colleagues. Am I actually helping anyone? Who knows? lol

So again, more thinking, more questions… ( #neuro #ENT focus)
3/ I was thinking about those 2 neurological cases:

24yo M, Meningitis/Encephalitis -NP swab, +CSF (JAPAN)
https://sciencedirect.com/science/article/pii/S1201971220301958…

58yo F, Acute Hemorrhagic Necrotizing Encephalopathy +NP swab, CSF unable to be tested for SARSCOV2 (USA/MI)
https://pubs.rsna.org/doi/10.1148/radiol.2020201187

Bizarre.
A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2

Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly. We report the first case of…

https://sciencedirect.com/science/article/pii/S1201971220301958
4/ And yet, there certainly have been other reports of neurological complaints, seizures, headaches, etc.

But why? How?

We know #SARSCOV2 has neuroinvasive potential based on SARS and MERS:
https://www.ncbi.nlm.nih.gov/pubmed/32104915 
5/ Then I thought about all of the reports of #Conjunctivitis, #Anosmia (loss of smell), and #Ageusia (loss of taste).

Could it be that in some people, viral invasion stops more superficially in the local mucosa than further down into the lungs/respiratory tract?
6/ ?Are the symptoms of #anosmia and #ageusia a result of viral #cytotoxic damage to epithelium and nerves of the mucosa of nose (olfactory nerve) and mouth (glossopharyngeal nerve IX) at time of initial infection vs damage higher up in the brain or #brainstem?
6/ ?Are the symptoms of #anosmia and #ageusia a result of viral #cytotoxic damage to epithelium and nerves of the mucosa of nose (olfactory nerve) and mouth (glossopharyngeal nerve IX) at time of initial infection vs damage higher up in the brain or #brainstem?
6/ ?Are the symptoms of #anosmia and #ageusia a result of viral #cytotoxic damage to epithelium and nerves of the mucosa of nose (olfactory nerve) and mouth (glossopharyngeal nerve IX) at time of initial infection vs damage higher up in the brain or #brainstem?
7/ ?Does direct invasion of #SARSCoV2 through the nasal or eye mucosa/nerves increase risk for intracranial invasion —> neurological findings?

?Have we seen other eye findings like Adie’s pupil (viral inflammation/destruction of cilliary ganglion)? Or trigeminal neuralgia?
7/ ?Does direct invasion of #SARSCoV2 through the nasal or eye mucosa/nerves increase risk for intracranial invasion —> neurological findings? ?Have we seen other eye findings like Adie’s pupil (viral inflammation/destruction of cilliary ganglion)? Or trigeminal neuralgia?
7/ ?Does direct invasion of #SARSCoV2 through the nasal or eye mucosa/nerves increase risk for intracranial invasion —> neurological findings? ?Have we seen other eye findings like Adie’s pupil (viral inflammation/destruction of cilliary ganglion)? Or trigeminal neuralgia?
7/ ?Does direct invasion of #SARSCoV2 through the nasal or eye mucosa/nerves increase risk for intracranial invasion —> neurological findings? ?Have we seen other eye findings like Adie’s pupil (viral inflammation/destruction of cilliary ganglion)? Or trigeminal neuralgia?
7/ ?Does direct invasion of #SARSCoV2 through the nasal or eye mucosa/nerves increase risk for intracranial invasion —> neurological findings? ?Have we seen other eye findings like Adie’s pupil (viral inflammation/destruction of cilliary ganglion)? Or trigeminal neuralgia?
8/ The American Academy of Ophthalmology has some interesting data:
https://www.aao.org/headline/alert-important-coronavirus-context

Interestingly, Li Wenliang, MD, the whistleblower ophthalmologist in Wuhan China died at the young age of 33 after contracting #SARSCoV2 from an asymptomatic glaucoma patient.
9/ ***Side note question: glossopharyngeal nerve connected to tongue and carotid artery —> direct route to carotid artery/ heart? (STOP IT ERIN STICK TO NEURO/ENT today!)

#Cardiology #cardiotwitter @ErinMichos @KTamirisaMD @HeartBobH @HeartOTXHeartMD #medtwitter
10/ #SARSCoV2 could travel through the vasculature to the peripheral nerves, eventually up to the cavernous sinus, where multiple nerves are in close proximity
--> maxillary, ophthalmic, abducens, oculomotor, trochlear
--> Following further up could then invade the brain stem
10/ #SARSCoV2 could travel through the vasculature to the peripheral nerves, eventually up to the cavernous sinus, where multiple nerves are in close proximity --> maxillary, ophthalmic, abducens, oculomotor, trochlear --> Following further up could then invade the brain stem
10/ #SARSCoV2 could travel through the vasculature to the peripheral nerves, eventually up to the cavernous sinus, where multiple nerves are in close proximity --> maxillary, ophthalmic, abducens, oculomotor, trochlear --> Following further up could then invade the brain stem
10/ #SARSCoV2 could travel through the vasculature to the peripheral nerves, eventually up to the cavernous sinus, where multiple nerves are in close proximity --> maxillary, ophthalmic, abducens, oculomotor, trochlear --> Following further up could then invade the brain stem
10/ #SARSCoV2 could travel through the vasculature to the peripheral nerves, eventually up to the cavernous sinus, where multiple nerves are in close proximity --> maxillary, ophthalmic, abducens, oculomotor, trochlear --> Following further up could then invade the brain stem
11/ Interestingly, in a #COVID19 MD/APP Facebook group: an Ophthalmologist in NJ operated on 2 cases of mildly symptomatic adolescents with significant clinical findings at time of eye surgery.

Unfortunately, it has not yet approved for a journal.
11/ Interestingly, in a #COVID19 MD/APP Facebook group: an Ophthalmologist in NJ operated on 2 cases of mildly symptomatic adolescents with significant clinical findings at time of eye surgery. Unfortunately, it has not yet approved for a journal.
11/ Interestingly, in a #COVID19 MD/APP Facebook group: an Ophthalmologist in NJ operated on 2 cases of mildly symptomatic adolescents with significant clinical findings at time of eye surgery. Unfortunately, it has not yet approved for a journal.
12/ ?Did that young man with the negative nasophargyneal swab but positive CSF, get infected from viral transmission to his eyes?

Again, who knows...I am not an expert...just forever clinically curious.

Keep thinking! Keep asking hard questions!
13/ If you are also curious or interested in my late night medical #COVID19 and #SARSCOV2 queries please check out my other 2 threads:
14/ #COVID19 as a #Biphasic Disease of #Hypercoagulable State and Endothelial Damage Followed by Immune Response https://threadreaderapp.com/thread/1249236555962646528.html
Thread by @ErinSandersNP: 1/ Big thanks all of you on @Twitter for the interest in my thread...

Thread by @ErinSandersNP: 1/ Big thanks all of you on @Twitter for the interest in my thread regarding current literature on #microthrombi aIt’s late, so of course, more thinking and more questions...

https://threadreaderapp.com/thread/1249236555962646528.html
15/ Hypercoagulable State in #COVID19 https://threadreaderapp.com/thread/1248512794749739008.html
Thread by @ErinSandersNP: 1/ #Frontline clinicians across the world are observing a #hypercoagula...

Thread by @ErinSandersNP: 1/ #Frontline clinicians across the world are observing a #hypercoagulable state in patients with #COVID19. Could td varied effects of the disease on multiple organ systems...

https://threadreaderapp.com/thread/1248512794749739008.html
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