The Neurologic Manifestations of Coronavirus Disease 2019 Pandemic: A Systemic Review

Abstract

Objective: Review and integrate the neurologic manifestations of the Coronavirus Disease 2019 (COVID-19) pandemic, to aid medical practitioners who are combating the newly derived infectious disease. Methods: We reviewed the clinical research, consisting of mainly case series, on reported neurologic manifestations of COVID-19. We also reviewed basic studies to understand the mechanism of these neurologic symptoms and signs. Results: We included 79 studies for qualitative synthesis and 63 studies for meta-analysis. The reported neurologic manifestations were olfactory/taste disorders (35.6%), myalgia (18.5%), headache (10.7%), acute cerebral vascular disease (8.1%), dizziness (7.9%), altered mental status (7.8%), seizure (1.5%), encephalitis, neuralgia, ataxia, Guillain-Barre syndrome, Miller Fisher syndrome, intracerebral hemorrhage, polyneuritis cranialis, and dystonic posture. Conclusions: Neurologic manifestations in COVID-19 may alert physicians and medical practitioners to rule in high-risk patients. The increasing incidence of olfactory/taste disorders, myalgia, headache, and acute cerebral vascular disease renders a possibility that COVID-19 could attack the nervous system. The cytokine secretion and bloodstream circulation (viremia) are among the most possible routes into the nervous system.

Keywords: ACE2; COVID-19; cytokine; headache; neurologic; olfactory; pandemic; taste.

Figure 1

Neurological Manifestations of COVID-19 and the proposed mechanism. The COVID-19 virus may cause neurologic manifestations by cytokines secretion, general circulation (viremia), or direct invasion via the numerous ACE2 receptors in the olfactory epithelium. The olfactory disorder may cause by the olfactory epithelium damage. Fever was believed to be caused by the effect of cytokines or hypothalamus functional pertubation. The seizure may cause by cytokines storm, severely illed condition, or the brain parenchyma involvement, especially the mesial temporal lobe. Altered mental status may be a consequence of multiple organ failure, severe infection, or brainstem involvement. Headache is caused by meningeal irritation.