Good article in the Journal of the Neurological Sciences June 16, 2020
In this systematic review, we will discuss the evidence on the occurrence of central nervous system (CNS) involvement and neurological manifestations in patients with COVID-19.
Through the search strategy, we could identify two articles about neurological involvement by COVID-19. One of these publications was a narrative review and the other one was a viewpoint. However, the authors scanned the reference lists of the included studies and could identify multiple references. One study, specifically investigated the neurological manifestations of COVID-19 and could document CNS manifestations in 25% of the patients. Most of the studies investigated the manifestations of COVID-19 in general.
While neurological manifestations of COVID-19 have not been studied appropriately, it is highly likely that some of these patients, particularly those who suffer from a severe illness, have CNS involvement and neurological manifestations. Precise and targeted documentation of neurological symptoms, detailed clinical, neurological, and electrophysiological investigations of the patients, attempts to isolate SARS-CoV-2 from cerebrospinal fluid, and autopsies of the COVID-19 victims may clarify the role played by this virus in causing neurological manifestations.
Coronavirus is one of the major viruses that primarily targets the human respiratory system, but it also has neuroinvasive capabilities and can spread from the respiratory tract to the central nervous system (CNS). Previous epidemics or pandemics of coronaviruses include the severe acute respiratory syndrome (SARS) in 2002 and the Middle East respiratory syndrome (MERS) in 2012. The most recent pandemic of coronavirus infection is coronavirus disease (COVID-19) that is caused by SARS-CoV2 [1,2]. The symptoms of COVID-19 infection usually appear after an incubation period of about five days. The most common symptoms of COVID-19 illness are fever, cough, and fatigue; other symptoms include headache, hemoptysis, and dyspnea, among others. In the most severe cases, patients may develop pneumonia, acute respiratory distress syndrome, acute cardiac problems, and multiorgan failure . The first cases of COVID-19 were reported in December 2019 ; however, when we searched the MEDLINE (accessed from PubMed), from December 01, 2019 to March 26, 2020, with the key word “COVID 19”, surprisingly 1655 articles were yielded. This shows that COVID-19 pandemic is of great global public health concern.
Coronavirus infections have been associated with neurological manifestations (e.g., febrile seizures, convulsions, change in mental status, and encephalitis) [2,3]. Neurotropic and neuroinvasive capabilities of coronaviruses have been described in humans. Upon nasal infection, coronavirus enters the CNS through the olfactory bulb, causing inflammation and demyelination . In this systematic review, we will discuss the evidence on the occurrence of CNS involvement and neurological manifestations in patients with COVID-19.