The Neurology and Neuropsychiatry of COVID-19

SARS-CoV-2 (Credit: CDC / Eckert & Higgins)

 

By Matt Butler, Mark Ellul, Tom Pollak, Benedict Michael and Tim Nicholson

Evidence on the neurological and neuropsychiatric manifestations and complications of COVID-19 infections is emerging and this is likely to accelerate as the pandemic develops and clinical syndromes are detected, characterised and their mechanisms investigated.

In this blog we will:

NB: Please report suspected cases via the Coronerve surveillance study – specific portals also exist for Paediatric Neurologists, Stroke Physicians & Psychiatrists reporting cases.

We will add other reporting systems as and when they are developed.

 

Summary of evidence to date

As of 1st May there have been 52 data papers (including case reports/series) and 27 reviews (including editorials/position papers).

The clinical syndromes reported so far include stroke (13 studies), GBS (8 studies), encephalopathy/encephalitis/mengingoencephalitis (8 studies) psychiatric (4 studies), epilepsy (3 studies), mixed neuropsychiatric (3 studies), other clinical syndromes (2 studies; ADEM and acute myelitis). There have also been epidemiology (10 studies) and mechanistic (1 study) studies.

We have also added some extra related papers of interest at the end.

Click on links of study types or syndromes above to go straight to the relevant papers in the database below

 

PUBLISHED RESEARCH DATABASE

The papers are separated into research papers and reviews, listed by topic in order of date of publication and were last updated on 1st May. Click on the titles to access the papers. We have added brief summaries of the papers and those judged to be of particular importance are denoted with an orange diamonds ().

If you would like to make any comments or suggestions, or alert us to new papers, please email matthew.butler@kcl.ac.uk

 

1. DATA PAPERS

Stroke

Publication date / reference: 01/05/2020 González-Pinto et al. Emergency Room Neurology in times of COVID-19: Malignant Ischemic Stroke and SARS-COV2 Infection. Eur J Neurol.

Summary: Single case report of a 36-year-old health care worker who suffered left MCA infarct in the context of a COVID-19 infection.


Publication date / reference: 30/04/2020  Beyrouti R, et al.  Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry.

Summary: Case series (n=6) of consecutive patients with acute ischaemic stroke and COVID-19 including demographic, clinical, radiological and laboratory characteristics().


Publication date / reference: 30/04/2020  Al Saiegh F et al. Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke. J Neurol Neurosurg Psychiatry.

Summary: Case series (n=2) stroke patients with positive nasal PCR but negative CSF PCR.


Publication date / reference: 30/04/2020 Al Saiegh et al. Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke. J Neurol Neurosurg Psychiatry.

Summary: Case series (n=2) with confirmed covid-19 on nasopharyngeal swab but not in CSF. Patient one developed a aneurysmal subarachnoid haemorrhage and patient two developed an ischaemic stroke with massive haemorrhagic conversion.


Publication date / reference: 28/04/2020  Oxley TJ et al. Large-Vessel Stroke as a Presenting Feature of COVID-19 in the Young. N Engl J Med. 

Summary: Case series (n=5) of large-vessel stroke in patients younger than 50 diagnosed with SARS-CoV-2


Publication date / reference: 23/04/2020  Zhang Y et al. Coagulopathy and Antiphospholipid Antibodies in Patients with COVID-19. N Engl J Med.

Summary: Case series (n=3) of stroke (as well as additional infarcts) positive for COVID-19 and antiphospholipid antibodies.


Publication date / reference: 23/04/2020 Lodigiani et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research.

Summary: Prospective observational study of 288 patients with confirmed COVID-19. Ischaemic stroke was diagnosed in 9 (2.5%) of included patients.


Publication date / reference: 23/04/2020  Lushina N, et al. Pulmonary, Cerebral, and Renal Thromboembolic Disease Associated with COVID-19 Infection. Radiology.

Summary: Single case report of 84-year-old man with thrombotic occlusion of the distal basilar artery concurrent with COVID-19 infection.


Publication date / reference: 21/04/2020 Moshayedi P et al. Triage of Acute Ischemic Stroke in Confirmed COVID-19 : Large Vessel Occlusion Associated With Coronavirus Infection. Front Neurol.

Summary: Single case report of an elderly patient with multiple infarctions (STEMI, ischaemic limbs) who subsequently developed left middle cerebral artery infarct in the context of COVID-19 infection.


Publication date / reference: 20/04/2020  Aggarwal G, et al. Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of published literature. Int J Stroke.

Summary: Meta-analysis of 4 studies showing 2.5-fold increase in OR of severe COVID-19 in patients with history of stroke. No statistically significant association of stroke with mortality in patients with COVID-19 infection.


Publication date / reference: 01/04/2020  Zhai P, et al. The impact of COVID-19 on ischemic stroke: A case report. Preprint (Research Square).

Summary: Single case report of 79 year old male diagnosed with acute ischemic stroke (lacunar infarction on CT imaging) presenting with right sided weakness. COVID-19 positive.


Publication date / reference: 13/03/2020 Li, Y. et al. Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study. Preprint (SSRN/Lancet). 

Summary: Case series (n=221) of patients with COVID-19. 11 (5%) developed acute ischemic stroke, 1 (0·5%) cerebral venous sinus thrombosis (CVST), and 1 (0·5%) cerebral haemorrhage


Publication date / reference: 27/03/2020 Sharifi-Razavi A et al. COVID 19 and Intra cerebral hemorrhage: Causative or Coincidental. New Microbes New Infect. 

Summary: Single case report of large cerebral haemorrhage concurrent with COVID-19 infection

 


Guillain-Barré Syndrome (GBS)

Publication date / reference: 30/04/2020 Alberti et al. Guillain-Barre syndrome related to COVID-19 infection. Neurol Neuroimmunol Neuroinflamm.

Summary: Single case report of a 71-year-old man who developed symptoms suggestive of GBS. As with some other reports, nasopharyngeal swab was positive for COVID-19 however CSF was negative for the virus.


Publication date / reference: 24/04/2020 Padroni, M et al.  Guillain-Barré syndrome following COVID-19: new infection, old complication? J Neurol.

Summary: Single case report of GBS in a 70-year-old with confirmed COVID-19 on nasopharyngeal swab


Publication date / reference: 18/04/2020 Virani, A et al. Guillain-Barré Syndrome associated with SARS-CoV-2 infection. ID Cases.

Summary: Single case report of progressive, ascending weakness associated with COVID-19 infection. Note patient had concurrent diarrhoeal illness too.


Publication date / reference: 17/04/2020 Gutiérrez-Ortiz, C et al. Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology

Summary: Case series (n=2) of patients with COVID-19 presenting acutely with Miller Fisher syndrome and polyneuritis cranialis.


Publication date / reference: 17/04/2020 Toscano, G et al. Guillain–Barré Syndrome Associated with SARS-CoV-2. N Engl J Med.

Summary: Case series (n=5) of Guillain–Barré syndrome after the onset of COVID-19. Four had a positive nasopharyngeal swab for SARS-CoV-2 at the onset of the neurologic syndrome.


Publication date / reference: 15/04/2020 Camdessanche, J.P et al. COVID-19 may induce Guillain–Barré syndrome. Revue Neurologique.

Summary: Single case report of GBS in a 64-year-old with confirmed COVID-19 on nasopharyngeal swab.


Publication date / reference: 14/04/2020 Sedaghat, Z et al. Guillain Barre syndrome associated with COVID-19 infection: A case report. J Clin Neurosci.

Summary: Single case report of 65-year-old male patient with progressive symmetric ascending quadraparesis, diagnosed as Guillain-Barré syndrome


Publication date / reference: 01/04/2020 Zhao, H et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol.

Summary: Single case report of Guillain-Barré syndrome contemporaneous with covid-19 infection. The authors speculate that this could have been due to a parainfective process, or even a coincidence

 


Encephalopathy, Encephalitis, Meningoencephalitis

Publication date / reference: 17/04/2020  Pilotto A, et al. Steroid-responsive severe encephalopathy in SARS-CoV-2 infection. Preprint (medRxiv)

Summary: Single case report of 60-year old subject with SARS-CoV-2 infection but only mild respiratory abnormalities who developed severe progressive encephalopathy.


Publication date / reference: 16/04/2020  Duong L, et al. Meningoencephalitis without Respiratory Failure in a Young Female Patient with COVID-19 Infection in Downtown Los Angeles, Early April 2020. Brain Behav Immun.

Summary: Single case report of meningoencephalitis. 41-year-old female presented with headache, fever and a new onset seizure associated with covid-19. Authors unable to send CSF for covid-19 analysis.


Publication date / reference: 25/03/2020 Moriguchi, T. et al. A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis

Summary: Single case of Meningitis/Encephalitis presenting with seizure. Nasopharyngeal swab negative for COVID-19 but detected in CSF. MRI demonstrated the abnormal findings of medial temporal lobe including hippocampus suggesting encephalitis.


Publication date / reference: 10/04/2020 Ye M et a. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun.

Summary: Single case report of a patient who presented meningeal irritation signs (including nuchal rigidity, Kernig sign and Brudzinski sign) and extensor plantar response were present. The CSF specimen was further tested for SARS-CoV-2 but the result was negative. The patient was treated as encephalitis associated with SARS-CoV-2 infection ‘after careful evaluation by neurological experts’.


Publication date / reference: 06/04/2020 Zhou L et al. SARS-CoV-2: Underestimated damage to nervous system. Travel Med Infect Dis.

Summary: Single case report of a 56-year-old patient with encephalitis. SARS-CoV-2 was detected in in the cerebrospinal fluid. Almost no additional clinical details.


Publication date / reference: 21/03/2020 Bernard-Valnet R et al. Two patients with acute meningo-encephalitis concomitant to SARS-CoV-2. medRxiv (preprint)

Summary: Case series (n=2) of patients that developed meningoencephalitic symptoms with neuropsychological impairment and pathological cerebrospinal fluid features concomitantly to SARS-CoV-2 documented infection. Both patients recovered promptly without treatment.


Publication date / reference: 21/03/2020 Filatov A. Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy. Cureus.

Summary: Single case report of a patient who presented with encephalopathy concurrently with COVID-19 infection.


Publication date / reference: 31/03/2020 Poyiadji N et al. COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy CT and MRI. Radiology.

Summary: Single case report of a patient with necrotising haemorrhagic encephalitis contemporaneous with but COVID-19 however not confirmed with positive CSF.

 


Psychiatric

Publication date / reference: 19/04/2020 Colizzi M et al. Medically unexplained symptoms in the times of COVID-19 pandemic: a case-report. Brain, Behav Immun.

Summary: Single case report of a patient diagnosed with a somatic covid syndrome. Presened with tachycardia, pyrexia, dyspnoea, fatigue, and altered olfactory and gustatory sensitivity. Bloods were normal and he had a negative covid swab.


Publication date / reference: 15/04/2020 Zhanga J et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun.

Summary: Cross-sectional study finding increased prevalence of depression (29.2%) in patients who experienced COVID-19 infection, while the prevalence of anxiety was not statistically different.


Publication date / reference: 31/03/2020  Nguyen HC et al. People with Suspected COVID-19 Symptoms Were More Likely Depressed and Had Lower Health-Related Quality of Life: The Potential Benefit of Health Literacy. J Clin Med.

Summary: Cross-sectional study which indicated that patients with symptoms of COVID-19 had a higher depression likelihood, particularly if they had low health literacy.


Publication date / reference: 24/03/2020 Yang, L. et al. Analysis of psychological state and clinical psychological intervention model of patients with COVID-19. medRxiv (preprint).

Summary: Prospective observational study of anxiety and depression symptoms. HAM-A and HAM-D scores of COVID-19 patients were higher than healthy controls and pneumonia (non-COVID-19) comparison group

 


Epilepsy

Publication date / reference: 18/04/2020 Lu L et al. New-onset acute symptomatic seizure and risk factors in Corona Virus Disease 2019: A Retrospective Multicenter Study. Epilepsia.

Summary: Retrospective case series (n=304) of COVID-19 positive patients: no seizures observed.


Publication date / reference: 21/04/2020 Vollono C et al. Focal status epilepticus as unique clinical feature of COVID-19 case report. Seizure.

Summary: Single case report of 78-year-old with focal status epilepticus. Past history (2 years ago) of HSV-1 encephalitis


Publication date / reference: 28/03/2020 Karimi, N et al. Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report. Iran Red Crescent Med

Summary: Single case report of a COVID-19 positive 30-year-old female (previously healthy) admitted with tonic-clonic seizures; 5 seizures in 8-hour period. CT and MRI head were negative.

 


Mixed neuropsychiatric

Publication date / reference: 15/04/2020 Yin R et al. Concomitant neurological symptoms observed in a patient diagnosed with coronavirus disease 2019. J Med Virol.

Summary: Single case report of a patient presenting with altered consciousness and some indications of contextually dissociated speech. Both lower limbs showed positive ankle clonus and extensor reflexes. Positive for the Brudzinski sign and the straight leg raise test. Treated with antivirals. LP was negative for 2019-nCoV nucleic acid test.


Publication date / reference: 15/04/2020 Helms J et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med.

Summary: Prospective observational study of Neurological features in a series of 58 of 64 consecutive patients. Positive findings on CAM-ICU (65%), agitation (69%), corticospinal tract signs (67%), dysexecutive syndrome (36%). Also summarises MRI brain findings().


Publication date / reference: 10/04/2020 Mao L et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol.

Summary:  Retrospective case series of 214 patients. Those with more severe infection had neurologic manifestations, such as acute cerebrovascular diseases (5.7%) and impaired consciousness (14.8%)().

 


Other Clinical Syndromes

Publication date / reference: 21/04/2020 Zhang T, et al. COVID-19-Associated Acute Disseminated Encephalomyelitis – A Case Report. medRxiv (preprint)

Summary: Single case report of Acute Disseminated Encephalomyelitis (ADEM) in a COVID-19 patient.


Publication date / reference: 18/03/2020 Zhao, K. et al. Acute myelitis after SARS-CoV-2 infection: a case report. medRxiv (preprint).

Summary: Single case report of acute myelitis. The patient was admitted with acute flaccid paralysis of the bilateral lower limbs and urinary and bowel incontinence.


Epidemiological data including neuropsychiatric symptoms

Publication date / reference: 30/04/2020 Lechien et al. Clinical and Epidemiological Characteristics of 1,420 European Patients with mild-to-moderate Coronavirus Disease 2019. J Int Med

Summary: Prospective observational study of 1420 patients in European hospitals with mild-to-moderate COVID-19 infection. Headache was seen in 70.3%. There were also reports of visual acuity reduction (N=6), rotatory vertigo (N=6), and tinnitus (N=5).


Publication date / reference: 28/04/2020 Docherty AB et al. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol.  medRxiv (preprint).

Summary: Prospective observational cohort study of 16,749 UK patients with COVID-19 which reports of headache (~10%), seizures (~1%), and confusion (~25%) upon presentation to hospital.


Publication date / reference: 15/04/2020 Zhu J, Ji P, Pang J, et al. Clinical characteristics of 3,062 COVID-19 patients: a meta-analysis. J Med Virol

Summary:  A meta-analysis of epidemiological data (3,062 COVID-19 patients). In total, 15.4% patients experienced headache.


Publication date / reference: 30/03/2020 Borges do Nascimento I et al. Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis. J Clin Med

Summary: Meta-analysis;12% of included COVID-19 positive patients had headache.


Publication date / reference: 26/03/2020 Chen T et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Brit Med J

Summary: Retrospective case series of 274 patients with COVID-19 who had died. In total, 23 (20%) of developed hypoxic encephalopathy after diagnosis of COVID-19.


Publication date / reference: 21/02/2020 Yang X et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med.

Summary: Retrospective case series of 52 critically ill patients found headache in 6%.


Publication date / reference: 19/02/2020 Xu XW et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: Retrospective case series. Brit Med J.

Summary: Retrospective case series of 62 patients admitted to hospital with laboratory confirmed SARS-CoV-2 infection found headache in 21 (34%).


Publication date / reference: 07/02/2020 Wang D et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. J Am Med Assoc.

Summary: Retrospective case series of 138 hospitalized patients found dizziness in 9% and headache in 7%.


Publication date / reference: 29/01/2020 Chen N et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet.

Summary: Retrospective case series of 99 patients. Confusion in 9%, headache in 8%.


Publication date / reference: 24/01/2020 Huang C et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet.

Summary: Prospective observational study of 41 admitted patients found headache in 8%.

 


Mechanisms

Publication date / reference: 21/04/2020 Paniz-Mondolfi A et al. Central Nervous System Involvement by Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2). J Med Virol.

Summary: Single case report of virus detected by TEM (transmission electron microscopy) in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem of patient with respiratory symptoms and confusion().

 


2. REVIEWS, EDITORIALS AND POSITION PAPERS

 

Publication date / reference: 29/04/2020 Prakash P. Does collapse of respiratory center in the brain responsible for breakdown of COVID-19 patients? ACS Chem. Neurosci.

Summary: The authors suggest that from the olfactory bulb, SARS-CoV-2 may target the deeper parts of the brain including the thalamus and brainstem


Publication date / reference: 28/04/2020.  Herman C, et al. Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19. Neurology.

Summary: Systematic review and meta-analysis which explores published data on neurological comorbidities and sequalae of COVID-19 patients.


Publication date / reference: 28/04/2020 Needham EJ et al. Neurological implications of COVID-19 infections. Neurocritical Care.

Summary: Pragmatic review paper which suggests that coincidental occurrence of COVID-19 neurological diseases is likely, and we must be cautious about inferring causal linkages. Also suggests that cases may be missed and that greater concern may be para-infectious neurological diseases ().


Publication date / reference: 25/04/2020 Natoli, S et al. Does SARS‐Cov‐2 invade the brain? Translational lessons from animal models. Eur J Neurol.

Summary: Looks to animal models to explore neuroinvasive potential of COVID-19.


Publication date / reference: 23/04/2020 Sellner J et al. The need for neurologists in the care of COVID-19 patients. Eur J Neurol.

Summary: Discusses need for neurologists to be involved in the care of COVID-19 patients.


Publication date / reference: 23/04/2020 Esposito, G et al. Can the enteric nervous system be an alternative entrance door in SARS-CoV2 neuroinvasion? Brain, Behavior, and Immunity.

Summary: The authors suggest that COVID-19 may invade the CNS via the enteric nervous system


Publication date / reference: 23/04/2020 Tipton PW et al. What can Parkinson’s disease teach us about COVID-19? Polish J Neurol Neurosurg.

Summary: The authors in this paper suggest trialling the antiparkinsonian and antiviral agents amantadine and memantine in COVID-19.


Publication date / reference: 23/04/2020 Roe K et al. Explanation for COVID-19 infection neurological damage and reactivations Explanation for COVID-19 infection reactivations. Transbound Emerg Dis.

Summary: Suggests that due to similarities with Nipah virus, COVID-19 virus could lay dormant in neurological tissue and be reactivated at later date.


Publication date / reference: 22/04/2020 Rao H et al. The emergence of a novel coronavirus (SARS‐CoV‐2) disease and their neuroinvasive propensity may affect in COVID‐19 patients. Med Virol.

Summary: Discusses theoretical microinvasive properties of COVID-19.


Publication date / reference: 22/04/2020 Brietzke E et al. Three Insights on Psychoneuroimmunology of Mood Disorders To Be Taken From the Covid-19 Pandemic. Brain, Behav Immun Heal.

Summary: Discusses potential for COVID-19 to cause reactive psychiatric syndromes


Publication date / reference: 22/04/2020 Das G et al. Neurological Insights of COVID-19 Pandemic. ACS Chem Neurosci.

Summary: Theoretical position paper.


Publication date / reference: 20/04/2020 Manji H et al. Neurology in a time of covid-19. J Neurol Neurosurg Psych

Summary: Calls for neurologists to be part of frontline COVID-19 care().


Publication date / reference: 20/04/2020 Liu K et al. Neurological manifestations of the coronavirus (SARS-CoV-2) pandemic 2019-2020. J Neurol Neurosurg Psych

Summary: Summarises some of the neurological data from COVID-19 patients so far.


Publication date / reference: 20/04/2020 Siniscalchi A et al. Could COVID-19 represent a negative prognostic factor in patients with stroke? Infect Control Hosp Epidemiol.

Summary: Calls for prospective register of stroke in COVID-19 in order to pool data on response to thrombolytic treatments


Publication date / reference: 20/04/2020 Markus HS et al. COVID-19 and Stroke – A Global World Stroke Organisation perspective. Int J Stroke.

Summary: Summarises challenges faced in stroke care during COVID-19 pandemic.


Publication date / reference: 17/04/2020 Bertran Recasens B et al. Lack of dyspnea in COVID-19 patients; another neurological conundrum? Eur J Neurol..

Summary: Suggests that the lack of dyspnoea in many COVID-19 patients may have a neurological cause, possibly through damage of pulmonary c-fibres.


Publication date / reference: 16/04/2020 Kabbani N et al. Does COVID-19 infect the brain? If so, smokers might be at a higher risk. Mol Pharmacol.

Summary: Authors predict that nicotine exposure through smoking can increase the risk for COVID19 neuroinfection based on known functional interactions between the nicotinic receptor and ACE2


Publication date / reference: 15/04/2020 Lippi, et al. SARS‐CoV‐2: at the crossroad between aging and neurodegeneration. Mov Disord.

Summary: The authors posit that severe acute respiratory distress syndrome coronavirus 2 infection may, in the long-term, lead to accelerated aging phenotypes in survivors, not only in affected tissues but also in other organs, including the brain.


Publication date / reference: 10/04/2020 Pleasure SJ et al. The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection. JAMA Neurol.

Summary: Editorial which summarises some of the neurological data so far.


Publication date / reference: 10/04/2020 Troyer, E.A et al. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, Behavior, and Immunity.

Summary: Draws on data of neuropsychiatric symptoms of past pandemics to suggest that prospective neuropsychiatric monitoring of covid-19 affective individuals should be undertaken.


Publication date / reference: 09/04/2020 Pérez C. Looking ahead: The risk of neurologic complications due to COVID-19. Neurol Clin Pract.

Summary: Summarises data on neurological manifestations from Wuhan and posits that given postmortem in patients infected with other coronaviruses have shown neurological infiltration, that we could expect to see the same in some COVID-19 patients


Publication date / reference: 09/04/2020 Nath A. Neurologic complications of coronavirus infections. Neurology.

Summary: Short article discussing possible neurological complications of COVID-19..


Publication date / reference: 08/04/2020 Conde Cardona G et al. Neurotropism of SARS-CoV 2: Mechanisms and manifestations. J Neurol Sci.

Summary: Authors suggests that respiratory distress is not only the result of pulmonary inflammatory structural damage, but also due to the damage caused by the virus in the respiratory centres of the brain.


Publication date / reference: 04/04/2020 Turtle L. Respiratory failure alone does not suggest central nervous system invasion by SARS-CoV-2. J Med Virol.

Summary: Author suggests that conclusions draw by Li et al. (and by extension Conde et al.) are misplaced and that potential neuroinfiltrative potential of COVID-19 does not necessarily contribute to respiratory failure.


Publication date / reference: 31/03/2020 Li Z et al. The brain, another potential target organ, needs early protection from SARS-CoV-2 neuroinvasion. Sci China Life Sci.

Summary: Calls on clinicians to be mindful of potential neurological effects of COVID-19.


Publication date / reference: 30/03/2020 Wu Y et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun.

Summary: Discusses biological mechanisms for potential COVID-19 CNS infections based on understanding of other coronaviruses. Some issues with the references in this paper.


Publication date / reference: 13/03/2020 Baig AM et al. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci.

Summary: Authors propose mechanisms for cerebral involvement of COVID-19 infection via ACE2 receptors.


Publication date / reference: 27/02/2020 Li Y‐C et al. The neuroinvasive potential of SARS‐CoV2 may play a role in the respiratory failure of COVID‐19 patients. J Med Virol.

Summary: Authors suggest that the potential invasion of SARS‐CoV2 is partially responsible for the acute respiratory failure of patients with COVID‐19.


EXTRAS

Case reported in the media of a 5-year-old child dying of necrotising encephalitis secondary to covid-19.


Interesting paper summarises the neuropsychiatric side effects of chloroquine, which has been touted as a potential treatment for COVID-19: Sato K et al. Neuropsychiatric adverse events of chloroquine : a real-world pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) database. medRxiv (preprint).


How does covid-19 kill? Paper on mechanisms in Science

 

SEARCH STRATEGY

 

  1. PubMed search: (COVID-19 OR SARS-CoV2 OR SARS-CoV-2) AND (neurol* OR neuropath* OR nervous system OR brain OR encephal* OR meningit* OR stroke OR guillain-barre syndrome OR cerebr* OR pysch* OR mania OR psycho* OR functional OR catatonia OR cognit* OR depress* OR anxi* OR obsessive OR behaviour OR epilep* OR seizure OR headache* OR migraine)
  2. MedRxiv search: COVID-19 OR SARS-CoV2 OR SARS-CoV-2 in ‘neurology’ and/or ‘psychiatry’ categories
  3. Hand review of references in included papers
  4. Databases and knowledge of experts
  5. Informal searches on Twitter
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