Neurological Manifestations in COVID-19 Patients: A Meta-Analysis

Abstract

Common symptoms such as dizziness, headache, olfactory dysfunction, nausea, vomiting, etc. in COVID-19 patients have indicated the involvement of the nervous system. However, the exact association of the nervous system with COVID-19 infection is still unclear. Thus, we have conducted a meta-analysis of clinical studies associated with neurological problems in COVID-19 patients. We have searched for electronic databases with MeSH terms, and the studies for analysis were selected based on inclusion and exclusion criteria and quality assessment. The Stats Direct (version 3) was used for the analysis. The pooled prevalence with 95% confidence interval of various neurological manifestations reported in the COVID-19 patients was found to be headache 14.6% (12.2–17.2), fatigue 33.6% (29.5–37.8), olfactory dysfunction 26.4% (21.8–31.3), gustatory dysfunction 27.2% (22.3–32.3), vomiting 6.7% (5.5–8.0), nausea 9.8% (8.1–11.7), dizziness 6.7% (4.7–9.1), myalgia 21.4% (18.8–24.1), seizure 4.05% (2.5–5.8), cerebrovascular diseases 9.9% (6.8–13.4), sleep disorders 14.9% (1.9–36.8), altered mental status 17.1% (12.3–22.5), neuralgia 2.4% (0.8–4.7), arthralgia 19.9% (15.3–25.0), encephalopathy 23.5% (14.3–34.1), encephalitis 0.6% (0.2–1.3), malaise 38.3% (24.7–52.9), confusion 14.2% (6.9–23.5), movement disorders 5.2% (1.7–10.4), and Guillain–Barre syndrome 6.9% (2.3–13.7). However, the heterogeneity among studies was found to be high. Various neurological manifestations related to the central nervous system (CNS) and peripheral nervous system (PNS) are associated with COVID-19 patients.

Stroke Incidence and Outcome in a Population With COVID-19

“… 15 However, a meta-analysis showed that the prevalence of cerebrovascular diseases was 9.9% with a range of 6.8% to 13.4%. 16 …”

Electrophysiological assessment in patients with COVID-19-related peripheral neuropathies and myopathies: a systematic review

“…Neurological manifestations associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or Coronavirus Disease-2019 (COVID-19) are common ( 1 ). These symptoms might be related to the central nervous system, causing dizziness, headache, seizures, ataxia, stroke, and altered consciousness, or the peripheral nervous system, such as loss of taste and smell, altered vision, and myalgia ( 2 ). Multiple pathogenesis of these neurological manifestations in COVID-19 were suggested, which are not necessarily caused by the direct effect of COVID-19 on the peripheral or central nervous system but might also occur secondary to a severe immunological reaction to viral infection ( 3 , 4 ).…”

Causal association of the brain structure with the susceptibility, hospitalization, and severity of COVID‐19: A large‐scale genetic correlation study

“…COVID‐19 symptoms mainly include respiratory symptoms, including fever and dry cough, with severe cases showing acute respiratory distress syndrome, infectious shock, and even death 2 . Moreover, neuroinvasive symptoms have been reported, including nonspecific symptoms (e.g., headache, fatigue, nausea), central neurological symptoms (e.g., altered mental status, sleep disorders, epilepsy, and encephalitis), and peripheral neurological symptoms (e.g., olfactory and gustatory dysfunction) 3,4 …”

“…neuroinvasive symptoms have been reported, including nonspecific symptoms (e.g., headache, fatigue, nausea), central neurological symptoms (e.g., altered mental status, sleep disorders, epilepsy, and encephalitis), and peripheral neurological symptoms (e.g., olfactory and gustatory dysfunction). 3,4 There are abnormal imaging changes in the brain anatomy related to COVID-19, including signal abnormalities in the medial temporal lobe, 5 soft cerebral enhancement, 6 abnormalities of white matter signal, 7 and thalamic hyperactivation. 8 Brain anatomy determines the brain's ability to resist external pathogens.…”