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Neurological manifestations have been reported in COVID-19; however, the route used by SARS-CoV-2 to enter the brain is still under debate. Recent studies have focused on the olfactory route. SARS-CoV-2 viral proteins were also detected in the glossopharyngeal and vagal nerves originating from the lower brainstem and in isolated cells of the brainstem. Our proof of concep in vivo real-time imaging study of mice using an indocyanine green dye indicated that the neurovascular component of the connective tissue of the respiratory mucosa can also provide an alternate route to the brain.

SARS-CoV-2: The Road Less Traveled—From the Respiratory Mucosa to the Brain