J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website http://www.neurores.org

Review

Volume 10, Number 4, August 2020, pages 113-121

SARS-CoV-2 and Nervous System - Neurological Manifestations in Patients With COVID-19: A Systematic Review

**Table 1.** Acute Vascular Neurological Manifestation in Patients With SARV-CoV-2 Infection
Study	Patients	Age (years)	Gender	UD	D-dimer	Type of stroke	Treatment	Death
Median; F: female; M: male; UD: underlying disorders; IS: ischemic stroke; ICH: intracerebral hemorrhage; ns: not specified.
				Hypertension: 100%
Avula et al, 2020 [4]	4	81	F: 75% M: 25%	Dyslipdemia: 75% Diabetes: 25%	Elevated: 50%	IS	Aspirin	75%
Saiegh et al, 2020 [5]	2	46.5	F: 50% M: 50%	None: 50% ns: 50%	ns	IS ICH	External ventricular drain and specific surgery	None
Beyrouti et al, 2020 [6]	6	69.8	F: 33.3% M: 66.6%	Hypertension: 66.6%	Elevated: 100%	IS	Anticoagulati on: 66.6% Intravenous thrombolysis: 16.6%	16.6%
Gonzalez-Pinto et al, 2020 [7]	1	36	F	ns	Elevated	IS	Supportive measures	No
Oxley et al, 2020 [8]	5	40.4	F: 20% M: 80%	Hypertension: 20% Dyslipdemia: 20% Diabetes: 40%	Elevated: 60%	IS	Aspirin: 60% Clot retrieval: 80% Intravenous thrombolysis: 20% Anticoagulati on: 40%	None
Moshayedi et al, 2020 [9]	1	80	M	Heart failure, cardiovascular shock and ischemic bilateral lower limbs	ns	IS	Supportive measures	No

Table 1. Acute Vascular Neurological Manifestation in Patients With SARV-CoV-2 Infection

Study

Patients

Age (years)

Gender

D-dimer

Type of stroke

Treatment

Death

Median; F: female; M: male; UD: underlying disorders; IS: ischemic stroke; ICH: intracerebral hemorrhage; ns: not specified.

Hypertension: 100%

Avula et al, 2020 [4]

F: 75%
M: 25%

Dyslipdemia: 75%
Diabetes: 25%

Elevated: 50%

Aspirin

75%

Saiegh et al, 2020 [5]

46.5

F: 50%
M: 50%

None: 50%
ns: 50%

IS
ICH

External ventricular drain and specific surgery

None

Beyrouti et al, 2020 [6]

69.8

F: 33.3%
M: 66.6%

Hypertension: 66.6%

Elevated: 100%

Anticoagulati on: 66.6%
Intravenous thrombolysis: 16.6%

16.6%

Gonzalez-Pinto et al, 2020 [7]

Elevated

Supportive measures

Oxley et al, 2020 [8]

40.4

F: 20%
M: 80%

Hypertension: 20%
Dyslipdemia: 20%
Diabetes: 40%

Elevated: 60%

Aspirin: 60%
Clot retrieval: 80%
Intravenous thrombolysis: 20%
Anticoagulati on: 40%

None

Moshayedi et al, 2020 [9]

Heart failure, cardiovascular shock and ischemic bilateral lower limbs

Supportive measures

**Table 2.** Acute Inflammatory Neurological Manifestation in Patients With SARV-CoV-2 Infection
Study	Age (gender)	Symptoms	BI	Type of inflamation	Treatment	Outcome
M: male; F: female; BI: blood investigation; ns: not specified.
Moriguchi et al, 2020 [10]	24 years (M)	Headache, fatigue, fever and consciousness disturbance	Elevated: white cell count, neutrophil dominant Decreased: lymphocytes, increased C-reactive protein	Meningitis/encephalitis	Intravenous ceftriaxone, vancomycin, acyclovir and corticosteroids	ns
Poyiadji et al, 2020 [11]	50 years (F)	Cough, fever and altered mental status	ns	Necrotizing hemorrhagic encephalopathy	Intravenous immunoglobulin	ns
Zanin et al, 2020 [12]	54 years (M)	Anosmia, ageusia and loss of consciousness	Elevated: C-reactive protein and fibrinogen Decreased: lymphocytes	Demyelinating lesions (brain and spine)	Antiretroviral, hydroxychloroquine, antiepileptic and corticosteroids	Discharged

Table 2. Acute Inflammatory Neurological Manifestation in Patients With SARV-CoV-2 Infection

Study

Age (gender)

Symptoms

Type of inflamation

Treatment

Outcome

M: male; F: female; BI: blood investigation; ns: not specified.

Moriguchi et al, 2020 [10]

24 years (M)

Headache, fatigue, fever and consciousness disturbance

Elevated: white cell count, neutrophil dominant
Decreased: lymphocytes, increased C-reactive protein

Meningitis/encephalitis

Intravenous ceftriaxone, vancomycin, acyclovir and corticosteroids

Poyiadji et al, 2020 [11]

50 years (F)

Cough, fever and altered mental status

Necrotizing hemorrhagic encephalopathy

Intravenous immunoglobulin

Zanin et al, 2020 [12]

54 years (M)

Anosmia, ageusia and loss of consciousness

Elevated: C-reactive protein and fibrinogen
Decreased: lymphocytes

Demyelinating lesions (brain and spine)

Antiretroviral, hydroxychloroquine, antiepileptic and corticosteroids

Discharged

**Table 3.** Late Neurological Manifestation in Patients With SARV-CoV-2 Infection
Study	Age (gender)	UD	Symptoms (onset days)	Diagnosis	Treatment	Outcome
M: male; F: female; UD: underlying disorders; ns: not specified.
Alberti et al, 2020 [13]	71 years (F)	Hypertension, abdominal aortic aneurysm and lung cancer	Paresthesia, weakness, and flaccid tetraparesis (3)	Guillain-Barr syndrome	Intravenous immunoglobulin, antiviral and hydroxychloroquine	Death
Virani et al, 2020 [14]	54 years (M)	ns	Complaints of numbness and weakness (2)	Guillain-Barr syndrome	Intravenous immunoglobulin, hydroxychloroquine	Discharged
Sedaghat et al, 2020 [15]	65 years (M)	Diabetes	Acute progressive symmetric ascending quadriparesis (5)	Guillain-Barr syndrome	Intravenous Immunoglobulin, hydroxychloroquine, lopinavir/ritonavir and azithromycin	Discharged
Zhao et al 2020 [16]	69 years (F)	ns	Acute weakness in both legs and severe fatigue (1)	Guillain-Barr syndrome	Intravenous immunoglobulin, arbidol, lopinavir and ritonavir	Discharged

Table 3. Late Neurological Manifestation in Patients With SARV-CoV-2 Infection

Study

Age (gender)

Symptoms (onset days)

Diagnosis

Treatment

Outcome

M: male; F: female; UD: underlying disorders; ns: not specified.

Alberti et al, 2020 [13]

71 years (F)

Hypertension, abdominal aortic aneurysm and lung cancer

Paresthesia, weakness, and flaccid tetraparesis (3)

Guillain-Barr syndrome

Intravenous immunoglobulin, antiviral and hydroxychloroquine

Death

Virani et al, 2020 [14]

54 years (M)

Complaints of numbness and weakness (2)

Guillain-Barr syndrome

Intravenous immunoglobulin, hydroxychloroquine

Discharged

Sedaghat et al, 2020 [15]

65 years (M)

Diabetes

Acute progressive symmetric ascending quadriparesis (5)

Guillain-Barr syndrome

Intravenous Immunoglobulin, hydroxychloroquine, lopinavir/ritonavir and azithromycin

Discharged

Zhao et al 2020 [16]

69 years (F)

Acute weakness in both legs and severe fatigue (1)

Guillain-Barr syndrome

Intravenous immunoglobulin, arbidol, lopinavir and ritonavir

Discharged

**Table 4.** Review of Retrospective Studies on Neurological Manifestations in Patients With COVID-19
Study	Patients with neurological symptoms	Age	BI	Neurological complication	Outcome	Limitation
BI: blood investigation; ns: not specified; EEG: electroencephalography.
Mao et al, 2020 [17]	53	ns	Lower lymphocyte, platelet counts and higher blood urea nitrogen levels	Ischemic stroke 7.5% and cerebral hemorrhage 1.9%	ns	Single-center study, all data were abstracted from the electronic medical records; no EEG study; no clear definition of symptoms; and no outcome information
Li et al, 2020 [3]	13	Age ranged from 32 to 91 years	High white blood cell, neutrophil counts and C-reactive protein levels; and lower lymphocyte counts	Ischemic stroke (84%), cerebral venous sinus thrombosis (7.6) and cerebral hemorrhage (7.6%)	Survive rate (61.5%); death rate (38.4%)	Single-center study; no EEG study; no clear definition of symptoms; and no outcome information
Lodigiani et al, 2020 [18]	9	Age ranged from 57 to 82	High D-dimer levels (> 249 ng/mL)	Ischemic stroke	Survive rate (77.7%); death rate (22.2%%)	Single-center study, they could not confirm whether thromboembolic events contributed substantially to such a dramatic mortality and no autopsies were routinely performed

Table 4. Review of Retrospective Studies on Neurological Manifestations in Patients With COVID-19

Study

Patients with neurological symptoms

Age

Neurological complication

Outcome

Limitation

BI: blood investigation; ns: not specified; EEG: electroencephalography.

Mao et al, 2020 [17]

Lower lymphocyte, platelet counts and higher blood urea nitrogen levels

Ischemic stroke 7.5% and cerebral hemorrhage 1.9%

Single-center study, all data were abstracted from the electronic medical records; no EEG study; no clear definition of symptoms; and no outcome information

Li et al, 2020 [3]

Age ranged from 32 to 91 years

High white blood cell, neutrophil counts and C-reactive protein levels; and lower lymphocyte counts

Ischemic stroke (84%), cerebral venous sinus thrombosis (7.6) and cerebral hemorrhage (7.6%)

Survive rate (61.5%); death rate (38.4%)

Single-center study; no EEG study; no clear definition of symptoms; and no outcome information

Lodigiani et al, 2020 [18]

Age ranged from 57 to 82

High D-dimer levels (> 249 ng/mL)

Ischemic stroke

Survive rate (77.7%); death rate (22.2%%)

Single-center study, they could not confirm whether thromboembolic events contributed substantially to such a dramatic mortality and no autopsies were routinely performed