Neurological involvement of coronavirus disease 2019: a systematic review

• Type of Material: Article
• Authors: Malik Ghannam, University of Minnesota, Minneapolis; Qasem Alshaer, Emory University; Mustafa Al-Chalabi, University of Toledo; Lara Zakarna, An-Najah National University; Jetter Robertson, University of Minnesota, Minneapolis; Georgios Manousakis, University of Minnesota, Minneapolis
• Language: English
• Date: 2020-06-19
• Publisher: SPRINGER HEIDELBERG
• Publication Version: Final Published Version
• Copyright Statement: © Springer-Verlag GmbH Germany, part of Springer Nature 2020
• Final Published Version (URL): http://dx.doi.org/10.1007/s00415-020-09990-2
• Title of Journal or Parent Work: JOURNAL OF NEUROLOGY
• Volume: 267
• Issue: 11
• Start Page: 3135
• End Page: 3153
• Grant/Funding Information: No funding was obtained for this study.
• Keywords: SARS; BRAIN; Clinical Neurology; COMPLICATIONS; Science & Technology; Neurological complications; COVID-19; Pandemic; SARS-CoV-2; INFECTION; Neurosciences & Neurology; VIRUS; RESPIRATORY SYNDROME CORONAVIRUS; Life Sciences & Biomedicine
• Research Categories: Biology, Neuroscience

Abstract

Background: In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Objective: To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. Methods: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. Results: We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. Conclusions: Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain–Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.