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. 2020 Jul 13;24(1):421.
doi: 10.1186/s13054-020-03121-z.

Neurological manifestations of COVID-19: a systematic review

Gaurav Nepal  1 , Jessica Holly Rehrig  2 , Gentle Sunder Shrestha  3 , Yow Ka Shing  4 , Jayant Kumar Yadav  1 , Rajeev Ojha  5 , Gaurab Pokhrel  6 , Zhi Lan Tu  7 , Dong Ya Huang  8
Affiliations

Neurological manifestations of COVID-19: a systematic review

Gaurav Nepal et al. Crit Care. .

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global spread of coronavirus disease (COVID-19). Our understanding of the impact this virus has on the nervous system is limited. Our review aims to inform and improve decision-making among the physicians treating COVID-19 by presenting a systematic analysis of the neurological manifestations experienced within these patients.

Methods: Any study, released prior to May 20, 2020, that reported neurological manifestations in patients infected by SARS-CoV-2 was systematically reviewed using the PRISMA (Preferred Reporting Items for Systemic review and Meta-Analysis) statement.

Results: Our systematic review included data from 37 articles: twelve retrospective studies, two prospective studies, and the rest case reports/series. The most commonly reported neurological manifestations of COVID-19 were myalgia, headache, altered sensorium, hyposmia, and hypogeusia. Uncommonly, COVID-19 can also present with central nervous system manifestations such as ischemic stroke, intracerebral hemorrhage, encephalo-myelitis, and acute myelitis, peripheral nervous manifestations such as Guillain-Barré syndrome and Bell's palsy, and skeletal muscle manifestations such as rhabdomyolysis.

Conclusion: While COVID-19 typically presents as a self-limiting respiratory disease, it has been reported in up to 20% of patients to progress to severe illness with multi-organ involvement. The neurological manifestations of COVID-19 are not uncommon, but our study found most resolve with treatment of the underlying infection. Although the timeliness of this review engages current challenges posed by the COVID-19 pandemic, readers must not ignore the limitations and biases intrinsic to an early investigation.

Keywords: Brain; COVID-19; Neurological manifestation; SARS-CoV-2.

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Conflict of interest statement

None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram depicting the flow of information through the different phases of a systematic review
Fig. 2
Fig. 2
Common neurological manifestations of COVID-19 expressed as percentage
See this image and copyright information in PMC

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