Neurological manifestations and neuroimaging findings in patients with SARS-CoV2-a systematic review

Nikita Mohan; Muhammad Ali Fayyaz; Christopher Del Rio; Navpreet Kaur Rajinder Singh Khurana; Sampada Sandip Vaidya; Esteban Salazar; John Joyce; Amrat Ayaz Ali

doi:10.1186/s41983-021-00322-3

Neurological manifestations and neuroimaging findings in patients with SARS-CoV2-a systematic review

Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):68. doi: 10.1186/s41983-021-00322-3. Epub 2021 Jun 2.

Authors

Nikita Mohan¹, Muhammad Ali Fayyaz², Christopher Del Rio³, Navpreet Kaur Rajinder Singh Khurana⁴, Sampada Sandip Vaidya⁵, Esteban Salazar³, John Joyce⁶, Amrat Ayaz Ali⁷

Affiliations

¹ Jawaharlal Nehru Medical College, Belagavi, Karnataka India.
² Quaid e Azam Medical College, Bahawalpur, Pakistan.
³ Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico.
⁴ Indira Gandhi Government Medical College & Mayo Hospital, Nagpur, Maharashtra India.
⁵ Kazan State Medical University, Kazan, Russia.
⁶ M.S Ramaiah Medical College, Bangalore, Karnataka India.
⁷ Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.

Abstract

Background: The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information.

Objective: To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2.To identify neuro-invasive pathways of COVID infection.

Methods: Relevant studies were identified through four databases-the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords-"COVID-19," "SARS-CoV2," "neurological manifestations," "neuroimaging," "CT," and "MRI." Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020.

Results: Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases.

Conclusion: The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.

Keywords: COVID-19; Neuro-invasive; Neuroimaging; SARS-CoV 2; Stroke.

Publication types

Review