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001 Neurological manifestations of coronavirus disease 2019: a comprehensive review
  1. Jonathon Fanning1,2,
  2. Samuel Huth1,
  3. Sung-Min Cho3,
  4. Chiara Robba4,
  5. David Highton5,
  6. Denise Battaglini4,6,
  7. Judith Bellapart-Rubio1,7,
  8. Jacky Suen8,
  9. Gianluigi Li Bassi8,9,
  10. Fabio Taccone10,
  11. Rakesh Arora11,
  12. Glenn Whitman12 and
  13. John Fraser1,8
  1. 1Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
  2. 2Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
  3. 3Neurosciences Critical Care Division, Departments of Neurology, Neurosurgery and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MA, USA
  4. 4San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa, Italy
  5. 5Department of Anaesthesia and Perioperative Services, The Princess Alexandra Hospital, Woolloongabba, QLD, Australia
  6. 6Department of Medicine, University of Barcelona, Barcelona, Spain
  7. 7Adult Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
  8. 8Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
  9. 9Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
  10. 10Department of Intensive Care, Hôpital Érasme, Brussels, Belgium
  11. 11Cardiac Sciences Program, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada
  12. 12Cardiac Intensive Care Services, Johns Hopkins Hospital and University, Baltimore, MA, USA


Background There is growing evidence that SARS-Cov-2 infection is associated with severe neurological complications. Understanding the nature and prevalence of these neurologic manifestations is essential for identifying higher-risk patients and projecting demand for ongoing resource utilisation. This review and meta-analysis report the neurologic manifestations identified in hospitalised COVID-19 patients and provide a preliminary estimate of disease prevalence.

Methods MEDLINE, Embase and Scopus were searched for studies reporting the occurrence of neurological complications in hospitalised COVID-19 patients.

Results A total of 2207 unique entries were identified and screened, among which 14 cohort studies and 53 case reports were included, reporting on a total of 8,577 patients. Central nervous system manifestations included ischemic stroke (n=226), delirium (n=79), intracranial haemorrhage (ICH, n=57), meningoencephalitis (n=13), seizures (n=3), and acute demyelinating encephalitis (n=2). Peripheral nervous system manifestations included Guillain-Barrè Syndrome (n=21) and other peripheral neuropathies (n=3). The pooled period prevalence of ischemic stroke from identified studies was 1.3% [95%CI: 0.9% – 1.8%, 102/7715] in all hospitalised COVID-19 patients, and 2.8% [95%CI: 1.0% - 4.6%, 9/318] among COVID-19 patients admitted to ICU. The pooled prevalence of ICH was estimated at 0.4% [95%CI: 0%-0.8%, 6/1006].

Conclusions The COVID-19 pandemic exerts a substantial neurologic burden which may have residual effects on patients and healthcare systems for years. Low quality evidence impedes the ability to accurately predict the magnitude of this burden. Robust studies with standardised screening and case definitions are required to improve understanding of this disease and optimise treatment of individuals at higher risk for neurologic sequelae.

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