SARS-CoV-2 and Nervous System - Neurological Manifestations in Patients With COVID-19: A Systematic Review

Abstract

Coronavirus (CoV) is a virus infectious disease with a considerable spectrum of clinical presentations. Symptoms ranged from asymptomatic infection to severe pneumonia that may lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and several clinical complications. Neurologic symptoms related to CoV have been described recently in the literature. The relationship between SARS-CoV-2 and the central nervous system (CNS) is still not clear. This review aimed to reveal the current knowledge regarding CNS manifestation in SARS-CoV-2. A systematic literature review was carried out to identify the particularities of coronavirus disease 2019 (COVID-19) in patients with CNS involvement, using the PubMed database between January 1, 2020 and April 30, 2020. Conference papers, reviews, published letters, editorials, studies in pregnant women and children, and studies only reporting on a specific factor were excluded. An initial search included as many as 83 articles. Out of the 83 screened articles, 32 were selected for full-text review. Sixteen studies were excluded because they did not analyze nervous system involvement in SARS-CoV-2 infection. Thus, 16 papers were included in this review. There were three retrospective studies and 13 case reports/series of cases. Data from the current literature reveal that patients who suffer from a severe illness have more CNS involvement, neurological symptoms (i.e., dizziness, headache) and an association with strokes. The severe patients had higher D-dimer and C-reactive protein levels than non-severe patients and presented multiple organ involvement, such as serious liver, kidney and muscle damage.

The case of fatal acute hemorrhagic necrotizing encephalitis in a two-month-old boy with Covid-19.

“…Among hospitalized children fever, chills and gastrointestinal symptoms prevail, whereas cough and respiratory signs are less common [Kim L. 2020]. It has been established that the SARS-CoV-2 virus has neuroinvasive properties [Iadecola C 2020, Severo Bem Junior L 2020. Neurologic complications such as malaise, headache and anosmia are common in all age groups, but more severe: dizziness, altered mental status, ischemic strokes, encephalopathy, and encephalitis have also been Here we present a unique case of fatal, fulminant acute hemorrhagic encephalitis in a SARS-CoV-2 infected infant.…”

Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

“…Indeed, multiple studies have addressed the frequency and characteristics of neurological dysfunction among COVID-19 patients, ( 28 , 29 ) but there is still a substantial gap in knowledge in several domains, specifically regarding critically ill patients. Both central and peripheral nervous system involvement have been extensively reported in ICU patients, either as a manifestation of systemic critical illness or its treatment.…”

Fatal Case of COVID-19 Pneumonia Associated with Acute Myelopathy

“…The reported COVID-19 cases with neurological manifestations tend to occur more frequently in severe infections and in older people with comorbidities, such as diabetes mellitus (DM) and hypertension [5,9]. It has been reported that SARS-CoV and MERS-CoV coronaviruses were detected in the CSF of a patient with encephalitis and acute respiratory distress syndrome [10], and these viruses along with COVID-19 have ACE-2 receptors on the respiratory epithelial cells, glial cells, neurons, and vascular endothelium [5,6], which may indicate that COVID-19 possibly target and damage the nerve tissues.…”