Central Nervous System Manifestations in COVID-19 Patients: A Systematic Review and Meta-analysis

Abstract

Background: At the end of December 2019, a novel respiratory infection, initially reported in China, known as COVID-19 initially reported in China, and later known as COVID-19, led to a global pandemic. Despite many studies reporting respiratory infections as the primary manifestations of this illness, an increasing number of investigations have focused on the central nervous system (CNS) manifestations in COVID-19. In this study, we aimed to evaluate the CNS presentations in COVID-19 patients in an attempt to identify the common CNS features and provide a better overview to tackle this new pandemic. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, Ovid, Embase, Scopus, and Google Scholar. Included studies were publications that reported the CNS features between January 1st, 2020, to April 20th, 2020. The data of selected studies were screened and extracted independently by four reviewers. Extracted data analyzed by using STATA statistical software. The study protocol registered with PROSPERO (CRD42020184456). Results: Of 2353 retrieved studies, we selected 64 studies with 11282 patients after screening. Most of the studies were conducted in China (58 studies). The most common CNS symptom of COVID-19 were Headache (8.69%, 95%CI: 6.76%-10.82%), Dizziness (5.94%, 95%CI: 3.66%-8.22%), and Impaired consciousness (1.9%, 95%CI: 1%-2.79%). Conclusions: The growing number of studies have reported COVID-19, CNS presentations as remarkable manifestations that happen. Hence, understanding the CNS characteristics of COVID-19 can help us for better diagnosis and ultimately prevention of worse outcomes.

Long‐COVID syndrome‐associated brain fog and chemofog: Luteolin to the rescue

“…These processed could contribute to the pathogenesis and symptoms of long-COVID syndrome and "chomobrain" and could be prevented by the flavonoid luteolin covid-19-patients-brains-noinfection#::text=In%20an% 20in%2Ddepth%20study,shortly%20after%20contracting% 20the%20disease.) These findings may explain the recent comprehensive reports of significantly increased neurologic 102 and psychiatric 103 disorders in COVID-19 patients, as well as in long-COVID syndrome patients. 104 Mast cells are ubiquitous in the body 37 and are critical for allergic diseases, 105 but also inflammation.…”

“…(https://www.nih.gov/news-events/news-releases/nih-study-uncovers-blood-vessel-damage-inflammation-covid-19-patients-brains-noinfection%23:%7E:text=In%20an%20in%2Ddepth%20study,shortly%20after%20contracting%20the%20disease.) These findings may explain the recent comprehensive reports of significantly increased neurologic 102 and psychiatric 103 disorders in COVID‐19 patients, as well as in long‐COVID syndrome patients 104…”

Could SARS-CoV-2 Spike Protein Be Responsible for Long-COVID Syndrome?

“…Long-COVID is particularly associated with neurological [35][36][37][38][39][40][41][42][43], neurodegenerative [38,44,45], psychiatric [46][47][48][49][50][51][52], and cognitive [47][48][49][50][51][52][53][54][55][56][57] problems, especially brain fog [23,25,26,46,[58][59][60][61][62]. In fact, over 90% of patients who were initially hospitalized for COVID-19 and had neurological symptoms had significantly worse outcome 6 months later [63].…”

Neuroimaging Findings in Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Many case studies have recently been published [7][8][9][10][11][12], which can be analyzed to better understand CNS involvement in COVID-19. Several relevant meta-analyses have recently been published, but most of the studies merely focused on clinical manifestations of COVID-19 (e.g., headache, smell disturbances, dizziness) [13][14][15][16][17]. One metaanalysis focused on neuroimaging findings of COVID-19 [18], but only four types of neuroimaging findings were evaluated (i.e., cerebral infarction, cerebral microhemorrhages, intracranial hemorrhage, and encephalitis/encephalopathy).…”