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Neurological manifestations of coronavirus infections - a systematic review.
Ann Clin Transl Neurol. 2020 10; 7(10):2057-2071.AC

Abstract

To optimize diagnostic workup of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, we systematically reviewed neurological and neuroradiological manifestations of SARS-CoV-2 and all other known human coronavirus species (HCoV). Which lessons can we learn? We identified relevant publications (until 26 July 2020) using systematic searches in PubMed, Web of Science, and Ovid EMBASE with predefined search strings. A total of 4571 unique publications were retrieved, out of which 378 publications were selected for in-depth analysis by two raters, including a total of 17549 (out of which were 14418 SARS-CoV-2) patients. Neurological complications and associated neuroradiological manifestations are prevalent for all HCoVs (HCoV-229E, HKU1, NL63, OC43, Middle East respiratory syndrome (MERS)-CoV, SARS-CoV-1, and SARS-CoV-2). Moreover there are similarities in symptomatology across different HCoVs, particularly between SARS-CoV-1 and SARS-CoV-2. Common neurological manifestations include fatigue, headache, and smell/taste disorders. Additionally, clinicians need to be attentive for at least five classes of neurological complications: (1) Cerebrovascular disorders including ischemic stroke and macro/micro-hemorrhages, (2) encephalopathies, (3) para-/postinfectious immune-mediated complications such as Guillain-Barré syndrome and acute disseminated encephalomyelitis, (4) (meningo-)encephalitis, potentially with concomitant seizures, and (5) neuropsychiatric complications such as psychosis and mood disorders. Our systematic review highlights the need for vigilance regarding neurological complications in patients infected by SARS-CoV-2 and other HCoVs, especially since some complications may result in chronic disability. Neuroimaging protocols should be designed to specifically screen for these complications. Therefore, we propose practical imaging guidelines to facilitate the diagnostic workup and monitoring of patients infected with HCoVs.

Authors+Show Affiliations

Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.Neuroimmunology and MS Research Section, Neurology Clinic, University Zurich, University Hospital Zurich, Zurich, Switzerland.Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Center of Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden. Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Neuroimmunology and MS Research Section, Neurology Clinic, University Zurich, University Hospital Zurich, Zurich, Switzerland.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

32853453

Citation

Almqvist, Jesper, et al. "Neurological Manifestations of Coronavirus Infections - a Systematic Review." Annals of Clinical and Translational Neurology, vol. 7, no. 10, 2020, pp. 2057-2071.
Almqvist J, Granberg T, Tzortzakakis A, et al. Neurological manifestations of coronavirus infections - a systematic review. Ann Clin Transl Neurol. 2020;7(10):2057-2071.
Almqvist, J., Granberg, T., Tzortzakakis, A., Klironomos, S., Kollia, E., Öhberg, C., Martin, R., Piehl, F., Ouellette, R., & Ineichen, B. V. (2020). Neurological manifestations of coronavirus infections - a systematic review. Annals of Clinical and Translational Neurology, 7(10), 2057-2071. https://doi.org/10.1002/acn3.51166
Almqvist J, et al. Neurological Manifestations of Coronavirus Infections - a Systematic Review. Ann Clin Transl Neurol. 2020;7(10):2057-2071. PubMed PMID: 32853453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurological manifestations of coronavirus infections - a systematic review. AU - Almqvist,Jesper, AU - Granberg,Tobias, AU - Tzortzakakis,Antonios, AU - Klironomos,Stefanos, AU - Kollia,Evangelia, AU - Öhberg,Claes, AU - Martin,Roland, AU - Piehl,Fredrik, AU - Ouellette,Russell, AU - Ineichen,Benjamin V, Y1 - 2020/08/27/ PY - 2020/06/23/received PY - 2020/07/30/revised PY - 2020/07/30/accepted PY - 2020/8/28/pubmed PY - 2020/10/21/medline PY - 2020/8/28/entrez SP - 2057 EP - 2071 JF - Annals of clinical and translational neurology JO - Ann Clin Transl Neurol VL - 7 IS - 10 N2 - To optimize diagnostic workup of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, we systematically reviewed neurological and neuroradiological manifestations of SARS-CoV-2 and all other known human coronavirus species (HCoV). Which lessons can we learn? We identified relevant publications (until 26 July 2020) using systematic searches in PubMed, Web of Science, and Ovid EMBASE with predefined search strings. A total of 4571 unique publications were retrieved, out of which 378 publications were selected for in-depth analysis by two raters, including a total of 17549 (out of which were 14418 SARS-CoV-2) patients. Neurological complications and associated neuroradiological manifestations are prevalent for all HCoVs (HCoV-229E, HKU1, NL63, OC43, Middle East respiratory syndrome (MERS)-CoV, SARS-CoV-1, and SARS-CoV-2). Moreover there are similarities in symptomatology across different HCoVs, particularly between SARS-CoV-1 and SARS-CoV-2. Common neurological manifestations include fatigue, headache, and smell/taste disorders. Additionally, clinicians need to be attentive for at least five classes of neurological complications: (1) Cerebrovascular disorders including ischemic stroke and macro/micro-hemorrhages, (2) encephalopathies, (3) para-/postinfectious immune-mediated complications such as Guillain-Barré syndrome and acute disseminated encephalomyelitis, (4) (meningo-)encephalitis, potentially with concomitant seizures, and (5) neuropsychiatric complications such as psychosis and mood disorders. Our systematic review highlights the need for vigilance regarding neurological complications in patients infected by SARS-CoV-2 and other HCoVs, especially since some complications may result in chronic disability. Neuroimaging protocols should be designed to specifically screen for these complications. Therefore, we propose practical imaging guidelines to facilitate the diagnostic workup and monitoring of patients infected with HCoVs. SN - 2328-9503 UR - https://www.unboundmedicine.com/medline/citation/32853453/Neurological_manifestations_of_coronavirus_infections___a_systematic_review_ L2 - https://doi.org/10.1002/acn3.51166 DB - PRIME DP - Unbound Medicine ER -