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Meta-Analysis
. 2021 Dec 7;97(23):e2269-e2281.
doi: 10.1212/WNL.0000000000012930. Epub 2021 Oct 11.

Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis

Shubham Misra  1 , Kavitha Kolappa  1 , Manya Prasad  1 , Divya Radhakrishnan  1 , Kiran T Thakur  1 , Tom Solomon  1 , Benedict Daniel Michael  1 , Andrea Sylvia Winkler  1 , Ettore Beghi  1 , Alla Guekht  1 , Carlos A Pardo  1 , Greta Karen Wood  1 , Sherry Hsiang-Yi Chou  1 , Ericka L Fink  1 , Erich Schmutzhard  1 , Amir Kheradmand  1 , Fan Kee Hoo  1 , Amit Kumar  1 , Animesh Das  1 , Achal K Srivastava  1 , Ayush Agarwal  1 , Tarun Dua  1 , Kameshwar Prasad  2
Affiliations
Meta-Analysis

Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis

Shubham Misra et al. Neurology. .

Abstract

Background and objectives: One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.

Methods: We searched PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE for studies from December 31, 2019, to December 15, 2020, enrolling consecutive patients with COVID-19 presenting with neurologic manifestations. Risk of bias was examined with the Joanna Briggs Institute scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% confidence intervals (CIs) were calculated for neurologic manifestations. Odds ratio (ORs) and 95% CIs were calculated to determine the association of neurologic manifestations with disease severity and mortality. Presence of heterogeneity was assessed with I 2, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.

Results: Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 patients with COVID-19, 89% of whom were hospitalized. Forty-one neurologic manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurologic symptoms included fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%), and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurologic diagnosis (pooled prevalence 2%). In patients with COVID-19 ≥60 years of age, the pooled prevalence of acute confusion/delirium was 34%, and the presence of any neurologic manifestations in this age group was associated with mortality (OR 1.80, 95% CI 1.11-2.91).

Discussion: Up to one-third of patients with COVID-19 analyzed in this review experienced at least 1 neurologic manifestation. One in 50 patients experienced stroke. In those >60 years of age, more than one-third had acute confusion/delirium; the presence of neurologic manifestations in this group was associated with nearly a doubling of mortality. Results must be interpreted with the limitations of observational studies and associated bias in mind.

Systematic review registration: PROSPERO CRD42020181867.

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Figures

Figure 1
Figure 1. PRISMA Flow Diagram for the Systematic Review and Meta-analysis
COVID-19 = coronavirus disease 2019; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2. Forest Plot Depicting the Pooled Prevalence of Stroke
CI = confidence interval.
Figure 3
Figure 3. Forest Plot Depicting the Association Between Presence of Neurologic Manifestations and Mortality of Patients With COVID-19 ≥60 Years of Age
CI = confidence interval; COVID-19 = coronavirus disease 2019; OR = odds ratio.
See this image and copyright information in PMC

Comment in

References

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