Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Abstract

Introduction: Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications.

Methods: This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19.

Results: Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported.

Conclusion: There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.

Keywords: COVID-19; Coronavirus; MERS-CoV; Neurological manifestations; SARS-CoV-1.

Fig. 1

PRISMA algorithm of this study

Fig. 2

Pie chart of the rate of published articles according to the country of origin

Fig. 3

Neurological Symptoms in COVID-19 (Designed with BioRender.com)

Fig 4

CT Angiography of the neck shows macro thrombus within the Common Carotid artery bifurcation extending into the Internal Carotid artery in a previously healthy 33-Year-Old woman. (From Fara MG et al. [95])

Fig. 5

Fluid-attenuated inversion recovery (FLAIR) mages show diffuse confluent white matter hyperintensity particularly at the left-side (A-D) without significant enhancement on T1-weighted brain MRI (C, F). Involvement of (black arrow), deep gray matter (black arrowhead), and dorsal midbrain (white arrow) is evident. From Abdi S et al. [123]

Fig. 6

Fluid-attenuated inversion recovery (FLAIR) image shows hyper intensities within the bilateral thalami and medial temporal lobes (arrows) and also evidence of hemorrhage on C, G, hypo intense signal (arrows) on susceptibility-weighted images(SWI) and rim enhancements in D, H. From Poyiadji N. et al. [148]

Fig. 7

Diffusion weighted image (DWI) shows high signal intensity in the splenium of corpus callosum. Apparent diffusion coefficient (ADC) map demonstrates correlated slight decrease in ADC. From Hayashi M et al. [160]

Fig. 8

Hyperintense lesions within the periventricular white matter, cerebellar peduncles and basal ganglia (white arrows), and the corpus callosum (red arrow) indicative of diffuse ischemic lesions on the FLAIR image. From Hanafi R, et al. [185]

Fig 9

FLAIR image shows cortical hyperintensity in the right gyrus (yellow arrowheads) in both axial and coronal sections and subtle hyperintensity in the bilateral olfactory bulbs (white arrowheads) in the coronal section. From Politi SL et al. [209]

Fig. 10

Venn diagram of neurological presentations in different CoV infections