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Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review.
Clin Neurol Neurosurg. 2020 07; 194:105921.CN

Abstract

BACKGROUND

Increasing research reports neurological manifestations of COVID-19 patients. SARS-CoV-2 shares homology with other human coronaviruses that have also had nervous system involvement.

OBJECTIVE

To review the neurological aspects of SARS-cov2 and other coronavirus, including transmission pathways, mechanisms of invasion into the nervous system, and mechanisms of neurological disease.

METHODS

We conducted a systematic review of articles in PubMed, SCOPUS and EMBASE data bases. Reviewed evidence is presented in sections of this manuscript which includes pathogenesis, neuro-invasion, encephalitis, Guillain-Barré, ADEM, multiple sclerosis, polyneuropathy, and cerebrovascular disease.

RESULTS

A total 67 studies were included in the final analysis of experimental studies, case reports, series of cases, cohort studies, and systematic reviews related to neurological manifestations of SARS- CoV-2 and other human coronavirus infections. The SARS-CoV-2 receptor is expressed in the nervous system. Common reported symptoms included hyposmia, headaches, weakness, altered consciousness. Encephalitis, demyelination, neuropathy, and stroke have been associated with COVID-19. Infection through the cribriform plate and olfactory bulb and dissemination through trans-synaptic transfer are some of the mechanisms proposed. Invasion of the medullary cardiorespiratory center by SARS-CoV-2 may contribute to the refractory respiratory failure observed in critically-ill COVID-19 patients.

CONCLUSION

An increasing number of reports of COVID-19 patients with neurological disorders add to emergent experimental models with neuro-invasion as a reasonable concern that SARS-CoV-2 is a new neuropathogen. How it may cause acute and chronic neurologic disorders needs to be clarified in future research.

Authors+Show Affiliations

Department of Neurology - Texas Tech University Health Science Center - Lubbock, TX, USA. Electronic address: montalvan.neurologia@gmail.com.Department of Neurology - Texas Tech University Health Science Center - Lubbock, TX, USA.Department of Neurology - Texas Tech University Health Science Center - Lubbock, TX, USA.Department of Neurology - Texas Tech University Health Science Center - Lubbock, TX, USA.National Autnomous University of Honduras, School of Medical Sciences, Tegucigalpa, Honduras.

Pub Type(s)

Case Reports
Journal Article
Systematic Review

Language

eng

PubMed ID

32422545

Citation

Montalvan, V, et al. "Neurological Manifestations of COVID-19 and Other Coronavirus Infections: a Systematic Review." Clinical Neurology and Neurosurgery, vol. 194, 2020, p. 105921.
Montalvan V, Lee J, Bueso T, et al. Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clin Neurol Neurosurg. 2020;194:105921.
Montalvan, V., Lee, J., Bueso, T., De Toledo, J., & Rivas, K. (2020). Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clinical Neurology and Neurosurgery, 194, 105921. https://doi.org/10.1016/j.clineuro.2020.105921
Montalvan V, et al. Neurological Manifestations of COVID-19 and Other Coronavirus Infections: a Systematic Review. Clin Neurol Neurosurg. 2020;194:105921. PubMed PMID: 32422545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. AU - Montalvan,V, AU - Lee,J, AU - Bueso,T, AU - De Toledo,J, AU - Rivas,K, Y1 - 2020/05/15/ PY - 2020/04/28/received PY - 2020/05/10/revised PY - 2020/05/11/accepted PY - 2020/5/19/pubmed PY - 2020/6/26/medline PY - 2020/5/19/entrez KW - COVID-19 KW - Coronavirus KW - Encephalitis KW - Neurological manifestations KW - SARS-CoV-2 SP - 105921 EP - 105921 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 194 N2 - BACKGROUND: Increasing research reports neurological manifestations of COVID-19 patients. SARS-CoV-2 shares homology with other human coronaviruses that have also had nervous system involvement. OBJECTIVE: To review the neurological aspects of SARS-cov2 and other coronavirus, including transmission pathways, mechanisms of invasion into the nervous system, and mechanisms of neurological disease. METHODS: We conducted a systematic review of articles in PubMed, SCOPUS and EMBASE data bases. Reviewed evidence is presented in sections of this manuscript which includes pathogenesis, neuro-invasion, encephalitis, Guillain-Barré, ADEM, multiple sclerosis, polyneuropathy, and cerebrovascular disease. RESULTS: A total 67 studies were included in the final analysis of experimental studies, case reports, series of cases, cohort studies, and systematic reviews related to neurological manifestations of SARS- CoV-2 and other human coronavirus infections. The SARS-CoV-2 receptor is expressed in the nervous system. Common reported symptoms included hyposmia, headaches, weakness, altered consciousness. Encephalitis, demyelination, neuropathy, and stroke have been associated with COVID-19. Infection through the cribriform plate and olfactory bulb and dissemination through trans-synaptic transfer are some of the mechanisms proposed. Invasion of the medullary cardiorespiratory center by SARS-CoV-2 may contribute to the refractory respiratory failure observed in critically-ill COVID-19 patients. CONCLUSION: An increasing number of reports of COVID-19 patients with neurological disorders add to emergent experimental models with neuro-invasion as a reasonable concern that SARS-CoV-2 is a new neuropathogen. How it may cause acute and chronic neurologic disorders needs to be clarified in future research. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/32422545/Neurological_manifestations_of_COVID_19_and_other_coronavirus_infections:_A_systematic_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(20)30264-X DB - PRIME DP - Unbound Medicine ER -