Exploring the clinical association between neurological symptoms and COVID-19 pandemic outbreak: A systematic review of current Literature

Abstract

Object: The novel severe acute respiratory syndrome (SARS)-CoV-2 outbreak has been declared a pandemic in March, 2020. An increasing body of evidence suggests that patients with the coronavirus disease (COVID-19) might have a heterogeneous spectrum of neurological symptomsMethods. A systematic search of two databases was performed for studies published up to April 17th, 2020. PRISMA guidelines were followed.Results: We included 13 studies evaluating 2499 patients with laboratory-confirmed COVID-19 infections. The median age of patients was 50.3 (IQR 9.6), and the rate of male patients was 50% (95% CI 47.9-52%). The most common reported comorbidities were hypertension and diabetes (18.7%, 95% CI 16.9-20.7% and 9%, 95% CI 7.4-11.3%, respectively). Headache was reported in 17.9% of patients (95% CI 16.1-19.8%), and dizziness in 13.9% (95% CI 10.7-18%). Fatigue or myalgia, hypo/anosmia, and gustatory dysfunction were reported in 24%, 55.2%, and 55.4%, of patients, respectively.Conclusions: These data support accumulating evidence that a significant proportion of patients with COVID-19 infection develop neurological manifestations, especially olfactory and gustatory dysfunction. The pathophysiology of this association is under investigation and warrants additional studies, Physicians should be aware of this possible association because during the epidemic period of COVID-19, early recognition of neurologic manifestations otherwise not explained would raise the suspect of acute respiratory syndrome coronavirus 2 infection.

Cerebral venous sinus thrombosis in patients with COVID-19 infection

“…A wide spectrum of neurological complications has been reported with the new version of corona virus (Covid-19) [3] , which could involve the acute cerebrovascular insult [8] .…”

“…COVID-19 disease shows a state of hypercoagulability with a high prevalence of venous thromboembolism associated with thrombotic complications mostly related to the pulmonary vasculature [6] , [12] , [13] , [14] . However; these thrombotic complications may involve the brain vasculature as well in 2% of patient with confirmed COVID-19 infection [3] .…”

“…Both patients in the current report died within one week of their initial symptoms in spite the aggressive medical and surgical treatment. Seizures attack was reported in few cases with COVID-19 infection [3] . The attacks of convulsion after COVID-19 infection may be due to blood–brain barrier breakdown with excessive release of pro-inflammatory cytokine leading to cortical irritation and seizures [31] , [32] .…”

“…The coronavirus disease (COVID-19) has been declared a pandemic in March 2020 [2] . Despite the COVID-19 infection is more frequently related to acute respiratory distress but there is an increasing evidence of a heterogeneous spectrum of multisystem involvement including the neurological complications [3] . Thromboembolic events after COVID-19 infection have been reported mainly in the pulmonary vasculature however; thromboembolic complications of the nervous system with subsequent cerebrovascular stroke have been increasingly reported [4] .…”

Potential neurological manifestations of COVID-19: a narrative review

“…The neuroinvasive potential of the Severe Acute Respiratory Syndrome novel coronavirus, SARS-CoV-2, is being recognized, with enhanced awareness that the associated infection, Coronavirus Diseases 2019 (COVID-19), might result in neurological injury. Indeed, there is a growing body of evidence to suggest that a subset of COVID-19 patients will experience neurological manifestations of the infection [ 1 ]. Since genomic studies show that the SARS-CoV-2 virus has similar homological sequences with two of its beta-coronavirus predecessors, the SARS-CoV associated with Severe Acute Respiratory Syndrome (SARS) [ 2 ] and the virus associated with Middle Eastern Respiratory Syndrome (MERS) [ 3 ], it is helpful to review the neurological symptoms of these two earlier diseases as the plausible link between COVID-19 and neurological symptoms are explored.…”