Neurologic Characteristics in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Abstract

Importance: Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease that has caused a global pandemic. The presenting symptoms are mainly respiratory symptom, yet studies have reported nervous system involvement in the disease. A systematic review and meta-analysis of these studies are required to understanding the neurologic characteristic of the disease and help physicians with early diagnosis and management. Objective: To conduct a systematic review and meta-analysis on the neurologic characteristics in patients with COVID-19. Evidence Review: Authors conducted a literature search through PubMed from January 1st, 2020 to April 8th, 2020. Furthermore, the authors added additional sources by reviewing related references. Studies presenting the neurologic features of COVID-19 patients in their data were included. Case reports and case series were also included in this review. The quality of the studies was assessed based on the Oxford Center for Evidence-Based Medicine guidelines. Selected studies were included in the meta-analysis of proportion and the heterogeneity test. Finding: From 280 identified studies, 33 were eligible, with 7,559 participants included. Most of the included studies were from China (29 [88%]). Muscle injury or myalgia was the most common (19.2%, 95%CI 15.4-23.2%) neurologic symptom of COVID-19, followed by headache (10.9%, 95%CI 8.62-13.51%); dizziness (8.7%, 95%CI 5.02-13.43%); nausea with or without vomiting (4.6%, 95%CI 3.17-6.27%); concurrent cerebrovascular disease (4.4%, 95%CI 1.92-7.91%); and impaired consciousness (3.8%, 95%CI 0.16-12.04%). Underlying cerebrovascular disease was found in 8.5% (95%CI 4.5-13.5%) of the studies. Conclusion: Neurologic findings vary from non-specific to specific symptoms in COVID-19 patients. Some severe symptoms or diseases can present in the later stage of the disease. Physicians should be aware of the presence of neurologic signs and symptoms as a chief complaint of COVID-19, in order to improve management and prevent a worsening outcome of the patients.

Neurological and Musculoskeletal Features of COVID-19: A Systematic Review and Meta-Analysis

“…This review has multiple strengths, such as the estimation of prevalence for both neurological and musculoskeletal manifestations, the inclusion of a large number of studies (n = 60) with considerable sample size (n = 11, 069), the assessment of methodological quality and the level of evidence, and the use of proportional meta-analyses for the quantitative data. In addition, even though two systematic reviews on the neurological features of COVID-19 have been published previously (96,97), this review seems to be the only one reporting symptoms such low-back and facial pain. Similarly, the study also has some limitations.…”

Neurological Aspects of SARS-CoV-2 Infection: Mechanisms and Manifestations

“…In a more recent report by Mao et al, a third of patients with COVID-19 presented non-specific neurological manifestations, including dizziness (16.8%), headache (13.1%), loss of consciousness (7.5%), and seizures (0.5%) (10). Two recent systematic reviews and meta-analyses showed that headache and dizziness are among the most frequent neurological symptoms affecting COVID-19 patients (71,72). Interestingly, headache can occur even in the absence of fever and can be manifested as a migraine, tension-type, or cluster headache (73).…”

Headache characteristics in COVID-19 pandemic-a survey study

“…There are some studies and reviews highlighting that the most common neurological symptom is headache, often accompanied by high fever, moreover headache can occasionally be seen alone as the first sign of the disease [2,7]. A recent meta-analysis reported that the prevalence of headache was 10.9% with a high level of heterogeneity [8]. Therefore, detailed questioning of the presence of headaches in patients who are admitted to the emergency and outpatient departments is still an important step in the prompt recognition of the infection in some patients.…”