A systematic review of neurological symptoms and complications of COVID-19

Abstract

Objective To study the frequency of neurological symptoms and complications in COVID-19 patients in a systematic review of the literature. Methods Relevant studies were identified through electronic explorations of PubMed, medRxiv, and bioRxiv. Besides, three Chinese databases were searched. A snowballing method searching the bibliographies of the retrieved references was applied to identify potentially relevant articles. Articles published within 1 year prior to April 20th, 2020, were screened with no language restriction imposed. Databases were searched for terms related to SARS-CoV-2/COVID-19 and neurological manifestations, using a pre-established protocol registered on the International Prospective Register of Systematic Reviews database (ID: CRD42020187994). Results A total of 2441 articles were screened for relevant content, of which 92 full-text publications were included in the analyses of neurological manifestations of COVID-19. Headache, dizziness, taste and smell dysfunctions, and impaired consciousness were the most frequently described neurological symptoms, the latter more often among patients with a severe or critical disease course. To date, only smaller cohort studies or single cases have reported cerebrovascular events, seizures, meningoencephalitis, and immune-mediated neurological diseases, not suitable for quantitative analysis. Conclusion The most frequent neurological symptoms reported in association with COVID-19 are non-specific for the infection with SARS-CoV-2. Although SARS-CoV-2 may have the potential to gain direct access to the nervous system, so far, SARS-CoV-2 was detected in the cerebrospinal fluid in two cases only. Standardized international registries are needed to clarify the clinical relevance of the neuropathogenicity of SARS-CoV-2 and to elucidate a possible impact of SARS-CoV-2 infection on common neurological disease, such as Alzheimer's, Parkinson's disease or multiple sclerosis.

Common genetic variation in humans impactsin vitrosusceptibility to SARS-CoV-2 infection

“…A subset of COVID-19 patients present with neurological symptoms (Mao et al, 2020), including headaches, dizziness, and defects in smell and taste reported in 12-60% of patients (Chen et al, 2020). COVID-19 has been associated with acute disseminated encephalomyelitis (ADEM) (Pilotto et al, 2020;Zhang et al, 2020), mid-and long-term sequels including classical Guillain-Barré syndrome (Toscano et al, 2020;Zhao et al, 2020a), and COVID-19-associated delirium (McLoughlin et al, 2020).…”

Letter: gastrointestinal symptoms pre‐admission are associated with greater severity of COVID‐19—authors' reply

“…8 SARS-CoV-2 is neurotropic and neurologic symptoms are more prevalent in patient with severe disease. 9 These numerous aetiologies for GI symptoms make it difficult to distinguish those that actually indicate disease progression. Our understanding of the virus is still limited; assessments of the long-term effects of COVID-19, particularly in patients with severe disease, are needed.…”

71/m mit Verwirrtheit, Kopfschmerzen und Fieber

“… Die am häufigsten berichteten Symptome sind Kopfschmerzen, Schwindel, Verlust von Geruchs- und/oder Geschmackssinn und eine qualitative Bewusstseinsstörung . Bei intensivpflichtigen Patienten, die an CoVID-19 erkrankt sind, treten Myoklonien, Okulomotorikstörungen, epileptische Anfälle , aber auch Dystonien auf [ 1 – 3 ]. Das häufigste dieser Symptome ist der Geruchs- und/oder Geschmacksverlust (Anosmie, Ageusie), der von ca.…”

“… Das häufigste dieser Symptome ist der Geruchs- und/oder Geschmacksverlust (Anosmie, Ageusie), der von ca. 60–80 % der Betroffenen berichtet wird [ 1 , 2 ]. …”

“… Weitere im Zusammenhang mit einer SARS-CoV‑2 Infektion berichtete neurologische Komplikationen betreffen sowohl das ZNS als auch das PNS [ 1 – 3 ]. ZNS-Komplikationen umfassen neurovaskuläre Manifestationen im Sinne ischämischer und hämorrhagischer Schlaganfälle und neuroimmunologische Komplikationen wie eine akute disseminierte Enzephalomyelitis (ADEM) und isolierte Myelitiden.…”