Comparing COVID-19-linked neurological complications with other viral infections
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(2020) 18:465 Deng et al. J Transl Med https://doi.org/10.1186/s12967-020-02633-0
Open Access
LETTER TO THE EDITOR
Comparing COVID‑19‑linked neurological complications with other viral infections Xiao Deng, Yew‑Long Lo and Eng ‑King Tan*
Keywords: COVID-19, SARS, Influenza, Cerebrovascular disease There are increasing reports of multi-system involvement in coronavirus disease 2019 (COVID-19). Among these, cerebrovascular diseases (CVD) in COVID patients have been highlighted to be associated with varied features and prognosis. COVID-19 may possess the similar mechanism and clinical characteristics as SARS, as the viruses causing them are under the same category and share highly homological genetic sequence. Influenza H1N1 and COVID-19 are comparable in terms of outbreak size as Influenza H1N1 also bring about global pandemic. However, to date, a detailed systematic comparison of neurological complications among COVID-19, SARSCoV-1 and Influenza H1N1 infections has not been carried out. To address this gap in knowledge, we compared the frequency, presentation and prognosis of neurological complications in COVID-19 with SARS and Influenza H1N1 infection (Tables 1, 2). This may provide further mechanistic insights into potential differences between COVID-19 and other viral infections. We searched PubMed from January, 2020 to June, 2020. The following key words were included: “COVID-19”, “SARS”, “influenza”, “cerebrovascular disease”, “neurological symptoms”, “neurological manifestations”. Two review authors (EK-T, XD) independently reviewed the included studies and extracted study characteristics. About 3% of COVID-19 patients reported acute CVD in a study from Wuhan [1], comparable to the reported frequency of 2.42% for SARS reported in Singapore [2].
Neurologic manifestations occurred both early and late stage in the course of the COVID-19 [3], with more clinical variability than SARS and H1N1 infections. The most common severe neurologic manifestations in COVID19 patients included acute CVD, impaired consciousness, and skeletal muscle injury, which appeared slightly higher than SARS and H1N1 patients [1, 2, 4, 5]. Acute symptomatic seizures or status epilepticus were not seen commonly in COVID-19 patients [6]. More children with H1N1 than adults suffered neurologic injury with poor outcome [7], whereas paediatric patients with COVID-19 were more likely to have better outcome than adults [8] (Table 1). For CVD in COVID-19, we noticed that a number of them were relatively young (less than 50 years and of male gender) (Table 2). There was no consistent pattern to the types of strokes, with reports of involvement in small, medium or large vessels [3, 9] (Table 2). The blockages of these vessels led to infarcts and in some cases frank bleeding. The prognosis depended on the severity of the strokes at presentations and associated complications. Not surprisingly, vascular risk factors such as hyperlipidaemia, diabetes and hypertension were present especially in the older group of patients [10]. These risk factor
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