Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature

Abstract

Objective To perform an updated review of the literature on the neurological manifestations of COVID-19-infected patients Methods A PRISMA-guideline-based systematic review was conducted on PubMed, EMBASE, and SCOPUS. Series reporting neurological manifestations of COVID-19 patients were studied. Results 39 studies and 68,361 laboratory-confirmed COVID-19 patients were included. Up to 21.3% of COVID-19 patients presented neurological symptoms. Headache (5.4%), skeletal muscle injury (5.1%), psychiatric disorders (4.6%), impaired consciousness (2.8%), gustatory/olfactory dysfunction (2.3%), acute cerebrovascular events (1.4%), and dizziness (1.3%), were the most frequently reported neurological manifestations. Ischemic stroke occurred among 1.3% of COVID-19 patients. Other less common neurological manifestations were cranial nerve impairment (0.6%), nerve root and plexus disorders (0.4%), epilepsy (0.7%), and hemorrhagic stroke (0.15%). Impaired consciousness and acute cerebrovascular events were reported in 14% and 4% of patients with a severe disease, respectively, and they were significantly higher compared to non-severe patients ( p < 0.05). Individual patient data from 129 COVID-19 patients with acute ischemic stroke (AIS) were extracted: mean age was 64.4 (SD ± 6.2), 78.5% had anterior circulation occlusions, the mean NIHSS was 15 (SD ± 7), and the intra-hospital mortality rate was 22.8%. Admission to the intensive care unit (ICU) was required among 63% of patients. Conclusion This updated review of literature, shows that headache, skeletal muscle injury, psychiatric disorders, impaired consciousness, and gustatory/olfactory dysfunction were the most common neurological symptoms of COVID-19 patients. Impaired consciousness and acute cerebrovascular events were significantly higher among patients with a severe infection. AIS patients required ICU admission in 63% of cases, while intra-hospital mortality rate was close to 23%. Electronic supplementary material The online version of this article (10.1007/s00415-020-10285-9) contains supplementary material, which is available to authorized users.

Hemorrhagic and ischemic stroke in patients with coronavirus disease 2019: incidence, risk factors, and pathogenesis - a systematic review and meta-analysis

“…There was a lack of data regarding the association between hemorrhagic and ischemic stroke and the severity of the disease and mortality rate of patients with COVID-19. One study reported that 63% of COVID-19 patients who experienced ischemic stroke required admission to the intensive care unit (ICU) 50 .…”

Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

“…Although COVID-19 is primarily a respiratory disease, neurological manifestations such as encephalopathy, acute cerebrovascular disease, epilepsy, and GBS are recognized as potential complications [ 2 – 4 ]. As COVID-19 continues to spread worldwide, relatively rare neurological phenomena associated with SARS-CoV-2 infection are increasingly reported.…”

“…Although patients typically present with fever, cough, shortness of breath, myalgia, and fatigue, neurological manifestations involving the central and peripheral nervous system have been reported since the beginning of the pandemic [ 2 ]. Commonly described neurological manifestations include impairment of smell and taste, encephalopathy, acute cerebrovascular disease, epilepsy, and Guillain–Barré syndrome (GBS) [ 2 – 4 ]. In context of the large volume of COVID-19 cases, relatively rare post-infectious or para-infectious descriptions of movement disorders, predominately involving acute-onset myoclonus or cerebellar ataxia, are becoming increasingly evident.…”

Reduced Activity in an Inpatient Liaison Psychiatry Service During the First Wave of the COVID-19 Pandemic: Comparison With 2019 Data and Characterization of the SARS-CoV-2 Positive Cohort

“…Currently, data are emerging on the neuropsychiatric complications associated with COVID-19 infections, which have shown similar prevalences ( 12 , 13 ). There have been some data to suggest that COVID-19 is associated with new-onset psychiatric disorders such as psychosis ( 14 , 15 ), however at the time of writing there is insufficient evidence to confirm this association ( 10 , 16 ).…”