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Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

  • Mohan, Nikita1
  • Fayyaz, Muhammad Ali2
  • del Rio, Christopher3
  • Khurana, Navpreet Kaur Rajinder Singh4
  • Vaidya, Sampada Sandip5
  • Salazar, Esteban3
  • Joyce, John6
  • Ali, Amrat Ayaz7
  • 1 Jawaharlal Nehru Medical College, Belagavi, Karnataka, India , Belagavi (India)
  • 2 Quaid e Azam Medical College, Bahawalpur, Pakistan , Bahawalpur (Pakistan)
  • 3 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico , Monterrey Nuevo Leon (Mexico)
  • 4 Indira Gandhi Government Medical College & Mayo Hospital, Nagpur, Maharashtra, India , Nagpur (India)
  • 5 Kazan State Medical University, Kazan, Russia , Kazan (Russia)
  • 6 M.S Ramaiah Medical College, Bangalore, Karnataka, India , Bangalore (India)
  • 7 Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan , Jamshoro (Pakistan)
Published Article
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Springer Berlin Heidelberg
Publication Date
Jun 02, 2021
DOI: 10.1186/s41983-021-00322-3
Springer Nature


BackgroundThe COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information.ObjectiveTo evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2.To identify neuro-invasive pathways of COVID infection.MethodsRelevant studies were identified through four databases—the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords—“COVID-19,” “SARS-CoV2,” “neurological manifestations,” “neuroimaging,” “CT,” and “MRI.” Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020.ResultsOur review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases.ConclusionThe information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.

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