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. 2021 Aug;268(8):2656-2665.
doi: 10.1007/s00415-020-10285-9. Epub 2020 Oct 30.

Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature

Federico Cagnazzo  1 , Caroline Arquizan  2 , Imad Derraz  3 , Cyril Dargazanli  3 , Pierre-Henri Lefevre  3 , Carlos Riquelme  3 , Nicolas Gaillard  2 , Isabelle Mourand  2 , Gregory Gascou  3 , Alain Bonafe  3 , Vincent Costalat  3
Affiliations

Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature

Federico Cagnazzo et al. J Neurol. 2021 Aug.

Abstract

Objective: To perform an updated review of the literature on the neurological manifestations of COVID-19-infected patients METHODS: A PRISMA-guideline-based systematic review was conducted on PubMed, EMBASE, and SCOPUS. Series reporting neurological manifestations of COVID-19 patients were studied.

Results: 39 studies and 68,361 laboratory-confirmed COVID-19 patients were included. Up to 21.3% of COVID-19 patients presented neurological symptoms. Headache (5.4%), skeletal muscle injury (5.1%), psychiatric disorders (4.6%), impaired consciousness (2.8%), gustatory/olfactory dysfunction (2.3%), acute cerebrovascular events (1.4%), and dizziness (1.3%), were the most frequently reported neurological manifestations. Ischemic stroke occurred among 1.3% of COVID-19 patients. Other less common neurological manifestations were cranial nerve impairment (0.6%), nerve root and plexus disorders (0.4%), epilepsy (0.7%), and hemorrhagic stroke (0.15%). Impaired consciousness and acute cerebrovascular events were reported in 14% and 4% of patients with a severe disease, respectively, and they were significantly higher compared to non-severe patients (p < 0.05). Individual patient data from 129 COVID-19 patients with acute ischemic stroke (AIS) were extracted: mean age was 64.4 (SD ± 6.2), 78.5% had anterior circulation occlusions, the mean NIHSS was 15 (SD ± 7), and the intra-hospital mortality rate was 22.8%. Admission to the intensive care unit (ICU) was required among 63% of patients.

Conclusion: This updated review of literature, shows that headache, skeletal muscle injury, psychiatric disorders, impaired consciousness, and gustatory/olfactory dysfunction were the most common neurological symptoms of COVID-19 patients. Impaired consciousness and acute cerebrovascular events were significantly higher among patients with a severe infection. AIS patients required ICU admission in 63% of cases, while intra-hospital mortality rate was close to 23%.

Keywords: Acute ischemic stroke; COVID-19; Neurological manifestations; SARS-CoV-2.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA diagram detailing the specifics of the systematic literature review
See this image and copyright information in PMC

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