Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis
Open Access
- 11 June 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Zeitschrift für Neurologie
- Vol. 267 (10), 2777-2789
- https://doi.org/10.1007/s00415-020-09974-2
Abstract
Background Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, clinical research on its neurological manifestations is thus far limited. In this study, we aimed to systematically collect and investigate the clinical manifestations and evidence of neurological involvement in COVID-19. Methods Three medical (Medline, Embase, and Scopus) and two preprints (BioRxiv and MedRxiv) databases were systematically searched for all published articles on neurological involvement in COVID-19 since the outbreak. All included studies were systematically reviewed, and selected clinical data were collected for meta-analysis via random-effects. Results A total of 41 articles were eligible and included in this review, showing a wide spectrum of neurological manifestations in COVID-19. The meta-analysis for unspecific neurological symptoms revealed that the most common manifestations were fatigue (33.2% [23.1–43.3]), anorexia (30.0% [23.2–36.9]), dyspnea/shortness of breath (26.9% [19.2–34.6]), and malaise (26.7% [13.3–40.1]). The common specific neurological symptoms included olfactory (35.7–85.6%) and gustatory (33.3–88.8%) disorders, especially in mild cases. Guillain–Barré syndrome and acute inflammation of the brain, spinal cord, and meninges were repeatedly reported after COVID-19. Laboratory, electrophysiological, radiological, and pathological evidence supported neurologic involvement of COVID-19. Conclusions Neurological manifestations are various and prevalent in COVID-19. Emerging clinical evidence suggests neurological involvement is an important aspect of the disease. The underlying mechanisms can include both direct invasion and maladaptive inflammatory responses. More studies should be conducted to explore the role of neurological manifestations in COVID-19 progression and to verify their underlying mechanisms.Keywords
Funding Information
- National Natural Science Foundation of China (81201026)
- National Natural Science Foundation of Hubei Province (2017CFB394, 2016CFB643)
- Key Support Project of fundamental frontier in Wuhan (2019020701011458)
This publication has 71 references indexed in Scilit:
- Difference Between Medical and Nonmedical Students on Knowledge, Practice, and Attitude Towards the Human Papillomavirus Vaccine in China: a Cross-Sectional StudyJournal of Cancer Education, 2021
- Human Coronaviruses and Other Respiratory Viruses: Underestimated Opportunistic Pathogens of the Central Nervous System?Viruses, 2019
- Regulatory T cells use arginase 2 to enhance their metabolic fitness in tissuesJCI Insight, 2019
- Anti–spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARS-CoV infectionJCI Insight, 2019
- Sepsis: developing new alternatives to reduce neuroinflammation and attenuate brain injuryAnnals of the New York Academy of Sciences, 2019
- Angiotensin-Converting Enzyme 2 in the Rostral Ventrolateral Medulla Regulates Cholinergic Signaling and Cardiovascular and Sympathetic Responses in Hypertensive RatsNeuroscience Bulletin, 2018
- A Double-Inactivated Severe Acute Respiratory Syndrome Coronavirus Vaccine Provides Incomplete Protection in Mice and Induces Increased Eosinophilic Proinflammatory Pulmonary Response upon ChallengeJournal of Virology, 2011
- Severe Acute Respiratory Syndrome Coronavirus Infection Causes Neuronal Death in the Absence of Encephalitis in Mice Transgenic for Human ACE2Journal of Virology, 2008
- Understanding the symptoms of the common cold and influenzaThe Lancet Infectious Diseases, 2005
- Cardiac arrest and joggingAnnals of Emergency Medicine, 1982