Neurological Involvement of Coronavirus Disease 2019: A Systematic Review

Abstract

Abstract Background: In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Although the most common presentations of COVID-19 are fever, cough and shortness of breath, several clinical observations indicate that COVID-19 does affect the central and peripheral nervous system. Methods: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 that were evident for neurological involvement. Results: We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.28 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n=40) had cerebrovascular insults, 28% (n=23) had neuromuscular disorders, 18.3% of the patients (n=15) had encephalitis or encephalopathy, and 2.4% (n=2) presented with status epilepticus. Conclusions: Neurological manifestations of COVID-19 infection are not rare, especially large vessel stroke, Guillain barre syndrome and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of COVID-19, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.