Neurological Involvement of Coronavirus Disease 2019: A Systematic Review

Abstract

Background: In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Although the most common presentations of COVID-19 are fever, cough and shortness of breath, several clinical observations indicate that COVID-19 does affect the central and peripheral nervous system. Methods: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 that were evident for neurological involvement. Results: We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.28 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n=40) had cerebrovascular insults, 28% (n=23) had neuromuscular disorders, 18.3% of the patients (n=15) had encephalitis or encephalopathy, and 2.4% (n=2) presented with status epilepticus. Conclusions: Neurological manifestations of COVID-19 infection are not rare, especially large vessel stroke, Guillain barre syndrome and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of COVID-19, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

“…7 A systematic review conducted by Ghannam et al showed that 23% of the patients also had complications of encephalopathy or encephalitis. 8 The results of both studies indicated the possibility of central nervous system involvement in the course of COVID-19 disease, with the presence of SARS-CoV-2 neurotropism. 9 Previous studies have reported cases of encephalitis related to COVID-19, with varying clinical appearance, laboratorial and imaging ndings.…”

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

“…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.…”

Meningoencephalitis Associated With Sars-Cov-2

“…The SARS-CoV-2 infection is not only a respiratory disease; neurological involvement is not rare. This has been clear from the first analysis of 214 cases of COVID-19 in Wuhan (China), where 36.4% (78) patients presented with neurological complications 19 .…”