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Initial investigations suggest that extracellular vesicles (EVs), which assist in the evasion of the host's immune response and achieve immune evasion in SARS\u2010CoV\u20102 systemic spreading, contribute to the virus's attack on the central nervous system (CNS). The pro\u2010inflammatory, pro\u2010coagulant, and immunomodulatory properties of EVs contents may directly drive neuroinflammation and cerebral thrombosis in COVID\u201019. Additionally, EVs have attracted attention as potential candidates for targeted therapy in COVID\u201019 due to their innate homing properties, low immunogenicity, and ability to cross the blood\u2010brain barrier (BBB) freely. Mesenchymal stromal\/stem cell (MSCs) secreted EVs are widely applied and evaluated in patients with COVID\u201019 for their therapeutic effect, considering the limited antiviral treatment. This review summarizes the involvement of EVs in COVID\u201019 neuropathology as carriers of SARS\u2010CoV\u20102 or other pathogenic contents, as predictors of COVID\u201019 neuropathology by transporting brain\u2010derived substances, and as therapeutic agents by delivering biotherapeutic substances or drugs. Understanding the diverse roles of EVs in the neuropathological aspects of COVID\u201019 provides a comprehensive framework for developing, treating, and preventing central neuropathology and the severe consequences associated with the disease.<\/jats:p>","DOI":"10.1002\/advs.202305554","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T23:14:53Z","timestamp":1703459693000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Extracellular Vesicles: The Invisible Heroes and Villains of COVID\u201019 Central Neuropathology"],"prefix":"10.1002","volume":"11","author":[{"given":"Haiqing","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology West China Hospital Sichuan University Laboratory of Anesthesia and Critical Care Medicine National\u2010Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology West China Hospital 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