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Published in: BMC Neurology 1/2021

Open Access 01-12-2021 | Myalgie | Research article

Neurological manifestations and complications of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis

Authors: Ahmed Yassin, Mohammed Nawaiseh, Ala Shaban, Khalid Alsherbini, Khalid El-Salem, Ola Soudah, Mohammad Abu-Rub

Published in: BMC Neurology | Issue 1/2021

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Abstract

Background

The spectrum of neurological involvement in COVID-19 is not thoroughly understood. To the best of our knowledge, no systematic review with meta-analysis and a sub-group comparison between severe and non-severe cases has been published. The aim of this study is to assess the frequency of neurological manifestations and complications, identify the neurodiagnostic findings, and compare these aspects between severe and non-severe COVID-19 cases.

Methods

A systematic search of PubMed, Scopus, EBSCO, Web of Science, and Google Scholar databases was conducted for studies published between the 1st of January 2020 and 22nd of April 2020. In addition, we scanned the bibliography of included studies to identify other potentially eligible studies. The criteria for eligibility included studies published in English language (or translated to English), those involving patients with COVID-19 of all age groups, and reporting neurological findings. Data were extracted from eligible studies. Meta-analyses were conducted using comprehensive meta-analysis software. Random-effects model was used to calculate the pooled percentages and means with their 95% confidence intervals (CIs). Sensitivity analysis was performed to assess the effect of individual studies on the summary estimate. A subgroup analysis was conducted according to severity. The main outcomes of the study were to identify the frequency and nature of neurological manifestations and complications, and the neuro-diagnostic findings in COVID-19 patients.

Results

44 articles were included with a pooled sample size of 13,480 patients. The mean age was 50.3 years and 53% were males. The most common neurological manifestations were: Myalgia (22.2, 95% CI, 17.2 to 28.1%), taste impairment (19.6, 95% CI, 3.8 to 60.1%), smell impairment (18.3, 95% CI, 15.4 to 76.2%), headache (12.1, 95% CI, 9.1 to 15.8%), dizziness (11.3, 95% CI, 8.5 to 15.0%), and encephalopathy (9.4, 95% CI, 2.8 to 26.6%). Nearly 2.5% (95% CI, 1 to 6.1%) of patients had acute cerebrovascular diseases (CVD). Myalgia, elevated CK and LDH, and acute CVD were significantly more common in severe cases. Moreover, 20 case reports were assessed qualitatively, and their data presented separately.

Conclusions

Neurological involvement is common in COVID-19 patients. Early recognition and vigilance of such involvement might impact their overall outcomes.
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Literature
4.
go back to reference Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2020;12(1):14.CrossRef Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2020;12(1):14.CrossRef
7.
go back to reference Xiang P, Xu XM, Gao LL, Wang HZ, Xiong HF, Li RH. First case of 2019 novel coronavirus disease with encephalitis. ChinaXiv. 2020;202003:00015. Xiang P, Xu XM, Gao LL, Wang HZ, Xiong HF, Li RH. First case of 2019 novel coronavirus disease with encephalitis. ChinaXiv. 2020;202003:00015.
15.
go back to reference Health NI of. National Heart Lung, and Blood Institute. Quality assessment tool for observational cohort and cross-sectional studies. 2014. Health NI of. National Heart Lung, and Blood Institute. Quality assessment tool for observational cohort and cross-sectional studies. 2014.
16.
go back to reference Health NI of. Quality Assessment tool for case series studies. The National Heart, Lung, and Blood Institute; 2017. Health NI of. Quality Assessment tool for case series studies. The National Heart, Lung, and Blood Institute; 2017.
21.
go back to reference Group OL of EW. The Oxford levels of evidence 2: Oxford centre for evidence-based medicine. University of Oxford; 2011. Group OL of EW. The Oxford levels of evidence 2: Oxford centre for evidence-based medicine. University of Oxford; 2011.
31.
go back to reference Xu X-W, Wu X-X, Jiang X-G, Xu K-J, Ying L-J, Ma C-L, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. [published correction appears in BMJ. 2020 Feb 27;368:m792]. BMJ. 2020;368:m606. Published 2020 Feb 19. Xu X-W, Wu X-X, Jiang X-G, Xu K-J, Ying L-J, Ma C-L, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. [published correction appears in BMJ. 2020 Feb 27;368:m792]. BMJ. 2020;368:m606. Published 2020 Feb 19.
43.
go back to reference Huang Y, Tu M, Wang S, Chen S, Zhou W, Chen D, et al. Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: A retrospective single center analysis. Travel Med Infect Dis. 2020;36:101606.CrossRefPubMedPubMedCentral Huang Y, Tu M, Wang S, Chen S, Zhou W, Chen D, et al. Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: A retrospective single center analysis. Travel Med Infect Dis. 2020;36:101606.CrossRefPubMedPubMedCentral
47.
go back to reference Yan X, Wang C, Peng D, Han X, Fan Y, Fang Z, et al. Clinical features, treatment and outcomes of 218 patients with COVID-19: A retrospective, multicenter study based on clinical classification. SSRN Electron J. 2020; Available from:. https://doi.org/10.2139/ssrn.3559594. Yan X, Wang C, Peng D, Han X, Fan Y, Fang Z, et al. Clinical features, treatment and outcomes of 218 patients with COVID-19: A retrospective, multicenter study based on clinical classification. SSRN Electron J. 2020; Available from:. https://​doi.​org/​10.​2139/​ssrn.​3559594.
54.
go back to reference Chen W, Chen C, Huang L, Ye K, Lv L, Qin Z, et al., Clinical Characteristics of 85 Patients Infected by SARS-CoV-2 in Guangxi, China (2020). Available at SSRN: https://ssrn.com/abstract=3559599 or /link?doi=10.2139/ssrn.3559599CrossRef Chen W, Chen C, Huang L, Ye K, Lv L, Qin Z, et al., Clinical Characteristics of 85 Patients Infected by SARS-CoV-2 in Guangxi, China (2020). Available at SSRN: https://​ssrn.​com/​abstract=​3559599 or /link?doi=10.2139/ssrn.3559599CrossRef
57.
59.
64.
go back to reference Villalba NL, Maouche Y, Ortiz MBA, Sosa ZC, Chahbazian JB, Syrovatkova A, et al. Anosmia and dysgeusia in the absence of other respiratory diseases: should COVID-19 infection be considered? Eur J Case Rep Intern Med. 2020;7:001641. https://doi.org/10.12890/2020_001641. Villalba NL, Maouche Y, Ortiz MBA, Sosa ZC, Chahbazian JB, Syrovatkova A, et al. Anosmia and dysgeusia in the absence of other respiratory diseases: should COVID-19 infection be considered? Eur J Case Rep Intern Med. 2020;7:001641. https://​doi.​org/​10.​12890/​2020_​001641.
83.
go back to reference Sohal S, Mossammat M. COVID-19 Presenting with Seizures. IDCases; 2020. p. e00782. Sohal S, Mossammat M. COVID-19 Presenting with Seizures. IDCases; 2020. p. e00782.
88.
go back to reference Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):1–5.CrossRef Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):1–5.CrossRef
115.
go back to reference Sharma K, Tengsupakul S, Sanchez O, Phaltas R, Maertens P. Guillain–Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report. SAGE Open Med Case Rep. 2019;7:2050313X19838750.PubMedPubMedCentral Sharma K, Tengsupakul S, Sanchez O, Phaltas R, Maertens P. Guillain–Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report. SAGE Open Med Case Rep. 2019;7:2050313X19838750.PubMedPubMedCentral
Metadata
Title
Neurological manifestations and complications of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis
Authors
Ahmed Yassin
Mohammed Nawaiseh
Ala Shaban
Khalid Alsherbini
Khalid El-Salem
Ola Soudah
Mohammad Abu-Rub
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2021
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-021-02161-4

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