Neurological manifestations and complications of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis

Abstract

Background The spectrum of neurological involvement in COVID-19 is not thoroughly understood. To the best of our knowledge, no systematic review with meta-analysis and a sub-group comparison between severe and non-severe cases has been published. The aim of this study is to assess the frequency of neurological manifestations and complications, identify the neurodiagnostic findings, and compare these aspects between severe and non-severe COVID-19 cases. Methods A systematic search of PubMed, Scopus, EBSCO, Web of Science, and Google Scholar databases was conducted for studies published between the 1st of January 2020 and 22nd of April 2020. In addition, we scanned the bibliography of included studies to identify other potentially eligible studies. The criteria for eligibility included studies published in English language (or translated to English), those involving patients with COVID-19 of all age groups, and reporting neurological findings. Data were extracted from eligible studies. Meta-analyses were conducted using comprehensive meta-analysis software. Random-effects model was used to calculate the pooled percentages and means with their 95% confidence intervals (CIs). Sensitivity analysis was performed to assess the effect of individual studies on the summary estimate. A subgroup analysis was conducted according to severity. The main outcomes of the study were to identify the frequency and nature of neurological manifestations and complications, and the neuro-diagnostic findings in COVID-19 patients. Results 44 articles were included with a pooled sample size of 13,480 patients. The mean age was 50.3 years and 53% were males. The most common neurological manifestations were: Myalgia (22.2, 95% CI, 17.2 to 28.1%), taste impairment (19.6, 95% CI, 3.8 to 60.1%), smell impairment (18.3, 95% CI, 15.4 to 76.2%), headache (12.1, 95% CI, 9.1 to 15.8%), dizziness (11.3, 95% CI, 8.5 to 15.0%), and encephalopathy (9.4, 95% CI, 2.8 to 26.6%). Nearly 2.5% (95% CI, 1 to 6.1%) of patients had acute cerebrovascular diseases (CVD). Myalgia, elevated CK and LDH, and acute CVD were significantly more common in severe cases. Moreover, 20 case reports were assessed qualitatively, and their data presented separately. Conclusions Neurological involvement is common in COVID-19 patients. Early recognition and vigilance of such involvement might impact their overall outcomes.

Update 2021: COVID-19 aus Sicht der Neurologie

“…5000 Patienten mit einer Verdopplung der Mortalität einher [3]. Eine Analyse großer Patientenkollektive findet sich für die Akutsitua-tion bei Yassin et al [4] und als 6-Monats-Follow-up bei Taquet et al [5].…”

COVID-19: neurologische Manifestationen – Update

“…Im Zusammenhang mit COVID-19 wurden neurologische und neuropsychiatrische Manifestationen unterschiedlichen Schweregrades mit einer Prävalenz von bis zu 57,4 % beschrieben [ 22 , 24 , 36 , 38 , 39 , 51 ]. Einer der aktuellsten und größten Review-Studien zufolge hatte ca.…”

“…ein Drittel eines Kollektivs aus 145.634 zumeist hospitalisierten COVID-19-Patienten im Zusammenhang mit der COVID-19-Erkrankung mindestens ein neurologisches/neuropsychiatrisches Symptom oder eine entsprechende Diagnose [ 24 ]. Die Heterogenität der klinischen Manifestationen ist hoch [ 17 , 24 , 51 ]. In ihrer Diversität wurden die neurologischen und neuropsychiatrischen Symptome und Krankheitsbilder wie folgt unterteilt [ 24 ]: unspezifische Symptome wie Kopfschmerzen, Verwirrtheit, Schwindel, Müdigkeit neuropsychiatrische Symptome wie Angst, Depression und Psychose Erkrankungen des zentralen Nervensystems wie Neuropathie der Hirnnerven (Anosmie/Dysgeusie werden hier mit eingeschlossen), Enzephalopathie, zerebrovaskuläre Erkrankung, Enzephalitis, akute demyelinisierende Erkrankung wie ADEM, Myelopathie Erkrankungen des peripheren Nervensystems wie Guillain-Barré-Syndrom und Varianten muskuloskeletale Symptome wie Myalgie …”

“…In den letzten Monaten konnten mit Hilfe einiger multizentrischer, meist retrospektiver Kohortenstudien, Review-Arbeiten und Metaanalysen die Erkenntnisse über die neurologischen Manifestationen einer COVID-19-Erkrankung aus ersten Berichten einzelner Fallstudien, Fallserien und Fall-Kontroll-Studien zu Beginn der COVID-19-Pandemie vertieft werden [ 24 , 36 , 38 , 42 , 49 , 51 ]. Es wurde deutlich, dass eine COVID-19-Infektion von einer breiten Palette neurologischer und neuropsychiatrischer Symptome begleitet werden kann, die von häufigen Symptomen wie Müdigkeit und Anosmie bis hin zu selteneren, aber schweren neurologischen Erkrankungen wie Enzephalopathie und Schlaganfall reichen [ 22 , 24 , 51 ].…”

COVID-19-related autoimmune disorders of central nervous system (CRAD-C): Is it a new entity?

“…This involvement takes place in different ways. The severe acute respiratory syndrome coronavirus 2 ( SARS - CoV - 2 ) itself can cause anosmia or encephalitis by directly involving the olfactory nerves or brain tissue, respectively [ 1 ]. However, one of the main characteristics of this virus is its immunogenic characteristic, which by involving different parts of the body, including autoimmune disorders of the CNS, can cause many autoimmune disorders [ 2 ].…”