A systematic review of neurological manifestations of SARS‐CoV‐2 infection: the devil is hidden in the details

Romoli, Michele; Jelčić, Ilijas; Bernard‐Valnet, Raphaël; García‐Azorín, David; Mancinelli, Luca; Akhvlediani, Tamar; Monaco, Salvatore; Taba, Pille; Sellner, Johann

doi:10.1111/ene.14382

Cited by 104 publications

(115 citation statements)

References 49 publications

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“…examined but, nevertheless, we can rule out a systematic and important infection of the brain following SARS-CoV-2 infection in hamster. This is consistent with a recent review of the literature which failed to indicate any central nervous manifestation of SARS-CoV-2 presence in human central nervous system (Romoli et al, 2020), however the neurotropic ability of SARS-CoV-2 remains controversial (Wang et al, 2020). Interestingly, SARS-CoV-1 has been shown to be neurotropic only using ACE2 humanized mice.…”

Section: Discussionsupporting

confidence: 89%

Massive transient damage of the olfactory epithelium associated with infection of sustentacular cells by SARS-CoV-2 in golden Syrian hamsters

Bryche

Albin

Murri

et al. 2020

Brain, Behavior, and Immunity

265

267

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Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Section: Discussionsupporting

confidence: 89%

Massive transient damage of the olfactory epithelium associated with infection of sustentacular cells by SARS-CoV-2 in golden Syrian hamsters

Bryche

Albin

Murri

et al. 2020

Brain, Behavior, and Immunity

265

267

View full text Add to dashboard Cite

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“…Secondly, the characteristic pattern of stroke in individuals with COVID-19, with an increased proportion of large artery occlusion, infarction involving multiple territories, and increased cryptogenic aetiology, suggests a causal relationship in at least a proportion of patients.Previous reports have been published with the attempt to clarify the relationship between stroke and COVID-19. These included narrative reviews(32,33), systematic reviews(9)(10)(11)34) and metaanalyses(34,35). While some authors have focused on the relationship between personal history of CVD and COVID-19(7, 8), we studied the incidence and risk factors for the occurrence of new CVD in concomitant SARS-CoV2 infection, searching for a specific profile of COVID-19associated stroke.…”

mentioning

confidence: 99%

Stroke in COVID-19: A systematic review and meta-analysis

Nannoni

Groot

Bell

et al. 2020

International Journal of Stroke

456

496

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Background: Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases (CVD) is unclear. Aims: We aimed to characterize the incidence, risk factors, clinical-radiological manifestations and outcome of COVID-19-associated stroke. Methods: Three medical databases were systematically reviewed for published articles on acute CVD in COVID-19 (December 2019-September 2020). The review protocol was previously registered (PROSPERO ID=CRD42020185476). Data were extracted from articles reporting ï³5 stroke cases in COVID-19. We complied with the PRISMA guidelines, and used the NewcastleâOttawa Scale to assess data quality. Data were pooled using a random-effects model. Summary of review: Of 2,277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0-1.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral haemorrhage was less common (11.6%). Patients with COVID-19 developing acute CVD, compared to those who did not, were older (pooled median difference=4.8 years; 95%CI:1.7-22.4), more likely to have hypertension (OR=7.35; 95%CI:1.94-27.87), diabetes mellitus (OR=5.56; 95%CI:3.34-9.24), coronary artery disease (OR=3.12; 95%CI:1.61-6.02), and severe infection (OR=5.10; 95%CI:2.72-9.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference=-6.0 years; 95%CI:-12.3 to -1.4), had higher NIHSS (pooled median difference=5; 95%CI:3-9), higher frequency of large vessel occlusion (OR=2.73; 95%CI:1.63-4.57), and higher in-hospital mortality rate (OR=5.21; 95% CI:3.43-7.90). Conclusions: Acute CVD is not uncommon in COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggest that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease.

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“…Kremer et al retrospectively reviewed the characteristics of 64 confirmed COVID-19 patients with neurological complications, who underwent a brain MRI; encephalitis was one of the most common neuroimaging finding (17%); moreover, patients with encephalitis were younger. In this work, the Authors were incline to accept the autoimmune/inflammatory theory, due to the absence of the virus in cerebrospinal fluid and the presence of signs of inflammation in both neuroimaging and cerebrospinal fluid 29 to check for intrathecal humoral immune reaction 32 . Moreover, recently the presence of SARS-CoV-2 RNA in the cerebrospinal fluid has been detected by genome sequencing in a patient with clinically proved meningoencephalitis in Japan 33 .…”

Section: Discussionmentioning

confidence: 99%

Meningoencephalitis Associated With Sars-Cov-2

İaconetta¹

2020

Translational Medicine @ UniSa

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The aim of this work is to clarify the incidence of meningitis/encephalitis in SARS-CoV-2 patients. We conducted an initial search in PubMed using the Medical Subject Headings (MeSH) terms "meningitis," and "encephalitis,", and "COVID-19" to affirm the need for a review on the topic of the relationship between meningitis/encephalitis and SARS-CoV-2 infection. We included case series, case reports and review articles of COVID-19 patients with these neurological symptoms. Through PubMed database we identified 110 records. After removal of duplicates , we screened 70 record, and 43 were excluded because they focused on different SARS-CoV-2 neurological complications. For eligibility, we assessed 27 fulltext articles which met inclusion criteria. Seven articles were excluded, and twenty studies were included in the narrative review, in which encephalitis and/or meningitis case reports/case series were reported. Neurological manifestations of COVID-19 are not rare, especially meningoencephalitis; the hypoxic/metabolic changes produced by the inflammatory response against the virus cytokine storm can lead to encephalopathy, and the presence of comorbidities and other neurological diseases, such as Alzheimer's disease, predispose to these metabolic changes. Further study are needed to investigate the biological mechanisms of neurological complications of COVID-19.

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A systematic review of neurological manifestations of SARS‐CoV‐2 infection: the devil is hidden in the details

Abstract: All authors are members of the Infectious Disease Panel of the European Academy of Neurology (EAN). PT and JS are the co-chairs. The Chair of the Scientific Committee of the EAN approved the addition of the phrase "for the Infectious Disease Panel of the EAN".

Cited by 104 publications

References 49 publications

Massive transient damage of the olfactory epithelium associated with infection of sustentacular cells by SARS-CoV-2 in golden Syrian hamsters

Massive transient damage of the olfactory epithelium associated with infection of sustentacular cells by SARS-CoV-2 in golden Syrian hamsters

Stroke in COVID-19: A systematic review and meta-analysis

Meningoencephalitis Associated With Sars-Cov-2

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