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Background Coronavirus disease 2019 (COVID-19), a global issue now, can have a variety of clinical manifestations. Hundreds of articles have discussed different aspects of this infectious disease, such as physiopathology, epidemiology, clinical manifestations and treatment protocols. Recently, neurological manifestations of the disease have been found to be pretty common among COVID-19 patients. Here, neurological symptoms of COVID-19 infection with a focus on non-cerebrovascular complications are discussed in a large study population. Methods Neurological symptoms of 891hospitalized COVID-19 patients from March to June 2020 in a major Hospital, Tehran, Iran, were reviewed. Demographic characteristics and neurological manifestations were analyzed. Results Among 891 hospitalized COVID-19 patients, the following symptoms were observed: headache(63.9%),sleeping problems(51.3%), hyposmia/anosmia(46%), dizziness(45.4%), hypogeusia (42.1%),memory issues(31.5%), auditory disturbances(17.5%), paralysis(3.7%) and seizures(1.7%). In 29.7% of the patients, a neurological symptom was the initiating symptoms of the infection. Females were more likely to show headache and dizziness compared to males (p value<0.05). Headache intensity was also higher in females compared to males (p value<0.05). Headache prevalence was lower in older patients (p value<0.05), while memory loss and impaired consciousness were higher by increasing age (p values= 0.002 and 0.001, respectively). Conclusion Neurological manifestations were common among COVID-19 patients under study. Headache, as the most common neurological symptom among COVID-19 patients, was the most prevalent and intense among the female population. Headache, dizziness, sleeping problems, hyposmia/anosmia and hypogeusia were common COVID-19 neurological manifestations, while memory issues, auditory disturbances, paralysis, and seizures were less common.

Acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is spreading around the world. Patients with coronavirus disease 2019 (COVID-19) typically present fever, cough, and respiratory illnesses. It has been revealed that the comorbidities can turn it into severe types, and the managements meet unpredicted complications. Here, we report a case of coronavirus disease 2019 (COVID-19) coincidence with confirmed acute Guillain-Barré syndrome (GBS). Ten days after admission and therapeutic process, the patient developed autonomic dysfunction. Despite respiratory support and receiving intravenous immunoglobulin, the patient died due to cardiac arrest. Albeit it is yet scientifically doubtful, there are raising concerns toward a possible association between GBS and SARS-CoV-2 infection, demonstrating potential neurological symptoms of COVID-19. Keywords Acute respiratory distress syndrome • COVID-19 • Guillain-Barré syndrome Abbreviations ARDS Acute respiratory distress syndrome CSF Cerebrospinal fluid COVID-19 Coronavirus disease 2019 GBS Guillain-Barré syndrome IVIG Intravenous immunoglobulin MERS Middle East respiratory syndrome RT-PCR Real-time reverse transcription polymerase chain reaction SARS Severe acute respiratory syndrome SARS-CoV-2 Severe acute respiratory syndrome-coronavirus-2 EMG Electromyography NCV Nerve conduction velocity * Reza Ranjbar

The COVID-19 mainly causes respiratory disorders with high infection and severe morbidity and mortality. Neurologists have concerns about potential neurological side effects, profits, and timing of COVID-19 vaccines. This study aimed to review systematically research for the COVID-19 vaccine and neurological complications. Data was searched in Scopus, ISI web of knowledge, Medline, PubMed, Wiley, Embase, International Clinical Trials Registry Platform and Clinical Trials, Cochrane Library, and Google Scholar. Two reviewer authors individually searched and assessed the titles and abstracts of all articles. The third reviewer resolved disagreement between them. Data were documented regarding study location, study design, type of complications, number of patients, various types of COVID-19 vaccine, and type of neurological complications. Six studies in COVID-19 vaccine and neurological complications include two studies about neurological manifestations after the mRNA vaccines, four records about side effects of vector-based vaccine were included in the study. The main neurological complication associated mRNA vaccines were body aches, paresthesia, and difficulty walking, erythema migrans lesion, fatigue, myalgia, and pain in the left lateral deltoid region. The major neurological complication related to vector-based vaccines were urinary retention difficulty, feeding and ambulating, arm soreness, mild fatigue, chills, left-sided facial droop, headaches, a generalized epileptic seizure, hemianopia, and mild aphasia, acute somnolence and right-hand hemiparesis, acute transverse myelitis, deep vein thrombosis in her left leg, a vigilance disorder and a twitching, a severe immobilizing opsoclonus myoclonus syndrome, and encephalitis. A large spectrum of severe neurological unfavorable has been reported. These complications could occur as a result of molecular stimulation and later neuronal damage. Generally, the advantages of COVID‐19 vaccination are dominant on the risks of a neurological complication at both individual and population levels. Future investigations will be required to find any relationship between neurological complications and COVID‐19 vaccines principally as new strains of the virus and new vaccines are technologically advanced against them.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents respiratory symptoms as the most common clinical manifestations. Similar to some other viral infections, it can cause severe neurological damages. Here, we describe a 40-year-old man case who initially was admitted to a major hospital with presenting 7 days with weak flu-like symptoms (cough) and fever then presented neurology signs for 3 days. Physical examination and brain magnetic resonance imaging (MRI) showed cerebral vasculopathy. Molecular testing was performed on nasopharyngeal swab by real-time reverse transcription polymerase chain reaction (RT-PCR) which was positive for SARS-CoV-2. The patient received supportive cares and was treated with routine antiplatelet therapy. He was improved and discharged 10 days after admission with no symptoms. Our findings report a 40-year-old man with flu-like symptoms that indicate cerebral vasculopathy that was discharged with no symptoms. Therefore, physicians should be monitor patients with worsening or progressive central nervous system results. The pathobiology of this virus is still incompletely known; therefore, extensive studies are needed to reveal the effect of COVID-19 on the nervous system.

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Background: The field of neurology encompasses a wide range of disease types, and recognizing the most common manifestations of these diseases, particularly in subgroups, is critical for improving appropriate diagnostic and therapeutic measures. Objectives: The purpose of this study was to determine the frequency of common manifestations of neurological diseases in patients referred to a military hospital’s internal neurology clinic. Methods: This was a cross-sectional descriptive study of patients referred to the internal neurology clinic of a reference military hospital, Tehran, Iran in 2020. The sampling was done at random using a checklist. Finally data was analyzed by using SPSS software. Results: Women made up the majority of patients in 336 samples 182 (54.2 %) versus 154 (45.8 %). The patients’ average age was 49.5±16.5 years, with 28.3 % (n=95) being elderly. The three most common complaints raised by patients were headache, movement disorder, and sensory disorder, accounting for 29.5%, 27.7%, and 27.7% of complaints, respectively. Seventeen patients (5.1%) also mentioned other issues, with anger, anxiety, depression, and nausea being the most common complaints. Conclusion: Headache, movement disorder, and sensory disorder are the most common neurological disorders referred to a military hospital. Because of the high prevalence of these issues, it is necessary to establish specialized clinics and conduct additional research to determine the most common types of sensory and movement disorders, as well as the most effective methods of prevention and treatment in medical centers.

Background The involvement of the central nervous system is a frequent yet underestimated complication of diabetes mellitus. Visual evoked potentials (VEP) are a simple, sensitive, and noninvasive method for detecting early alterations in central optic pathways. The objective of this paralleled randomized controlled trial was to evaluate the impact of ozone therapy on visual pathways in diabetic patients. Methods Sixty patients with type 2 diabetes visiting clinics of Baqiyatallah university in Tehran (Iran) hospital were randomly assigned to two experimental groups: Group 1 (N = 30) undergoing a cycle of 20 sessions of systemic oxygen-ozone therapy in addition to standard therapy for metabolic control; Group 2 (N = 30)—serving as control—receiving only standard therapy against diabetes. The primary study endpoints were two VEP parameters; P100 wave latency and P100 amplitude at 3 months. Moreover, HbA1c levels were measured before the start of treatment and three months later as secondary study endpoint. Results All 60 patients completed the clinical trial. P100 latency significantly reduced at 3 months since baseline. No correlation was found between repeated measures of P100 wave latency and HbA1c (Pearson’s r = 0.169, p = 0.291). There was no significant difference between baseline values and repeated measures of P100 wave amplitude over time in either group. No adverse effects were recorded. Conclusions Ozone therapy improved the conduction of impulses in optic pathways of diabetic patients. The improved glycemic control following ozone therpay may not fully explain the reduction of P100 wave latency though; other mechanistic effects of ozone may be involved.