Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic revi
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REVIEW
Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS‑CoV‑2: a systematic review and meta‑analysis Lei Wang1 · Yin Shen1 · Man Li2 · Haoyu Chuang3,4,5 · Youfan Ye6 · Hongyang Zhao1 · Haijun Wang1 Received: 14 May 2020 / Revised: 1 June 2020 / Accepted: 4 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 COVID-19 · SARS-CoV-2 · Neurological manifestations · Systematic review · Inflammation
Introduction Lei Wang and Yin Shen contributed equally to the manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-09974-2) contains supplementary material, which is available to authorized users. * Haijun Wang [email protected] 1
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Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277, Jiefang Avenue, Wuhan 430022, Hubei Province, China Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
In December 2019, numerous patients had been diagnosed with unexplained pne
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