Neurological manifestations of Covid-19: a literature review
DOI:
https://doi.org/10.33448/rsd-v11i2.25470Keywords:
SARS-CoV-2; Neurologic manifestations; Covid-19.Abstract
This article aimed to analyze the research published so far on the neurological symptoms of Covid-19 and present the main results observed, in order to provide a greater understanding of the broad dimension of the disease and, thus, contribute to the identification of this symptomatology occur in a timely manner. This is an integrative literature review, guided by scientific articles indexed in the Google Academic database, National Library of Medicine (PubMED), Latin American and Caribbean Literature in Health Sciences (LILACS) and Scientific Electronic Library Online (SciELO), between the years 2020 and 2021. For this purpose, the descriptors "manifestations", "neurological", "Covid-19" and their respective counterparts in English and Spanish were used. In the literature, definitive conclusions are lacking about the time of onset of neuro-Covid manifestations, as well as which ones are more severe. Furthermore, the prognosis of this condition remains uncertain. Regarding the frequently reported symptoms, there was a predominance of stroke (6.0% - 74.0%), headache (9.0% - 72.0%), dysgeusia (5.6% - 41.0%), anosmia (5.1% - 41.0%), altered level of consciousness (31.0% - 39.0%) and seizure (5.0% - 29.7%). Guillain-Barré syndrome, meningitis, and myelopathy were uncommon diagnoses. The initial identification of neurological disorders comes from correctly performed anamnesis and physical examination, and, once the diagnosis is established, the correct management of the patient becomes essential, and, although there is no specific treatment for neurological symptoms, support measures and certain pharmacological therapies have been adopted for the care of the diseased.
References
Ahmad, I. & Rathore, F. A. (2020). Neurological manifestations and complications of COVID-19: A literature review. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia, 77, 8–12.
Beghi, E., Giussani, G., Westenberg, E., Allegri, R., Garcia-Azorin, D., Guekht, A., Frontera, J., Kivipelto, M., Mangialasche, F., Mukaetova-Ladinska, E. B., Prasad, K., Chowdhary, N. & Winkler, A. S. (2021). Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions. Journal of Neurology. 21, 1–10.
Bem Junior, L. S., Brito, T. V. B., Ferreira Júnior, A. G., Ribeiro, M. G. L., Alexandrino Júnior, J. S. & Brito, T. M. M. (2020). Neurotropismo viral: o que já sabemos de semelhanças com o novo coronavírus? COVID-19 no Brasil os múltiplos olhares da ciência para compreensão e formas de enfrentamento, 5, 6, 49-59.
Brandão, M. L. L., Rodrigues, F. O. S., Gomes, L. B., Netto, E. L. B., Moura, B. N. G., Lopes, B. C., Menezes, R. V. A., Amaral, L. A., Pereira, B. F. B.,
Campos, T. F., Aquino, I. P. & Oliveira, D. L. V. (2021). Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P): Uma análise epidemiológica brasileira. Research, Society and Development, 10, 9, e44710918154.
Campos, L. N., Costa, A. C. S., Cerqueira, D. D. N., Rangel, G. R., Andrade, I. C. F., Souza, S. C. B., Silva, J. C. D. M., Costa, B. M. C. & Rocha, S. W. S. (2020). COVID-19 neurological manifestations: a narrative review on the mechanisms, pathogenesis, and clinical management. Research, Society and Development, 9, 12, e4291210724.
Carcamo Garcia, M. H., Garcia Choza, D. D., Salazar Linares, B. J. & Diaz, M. M. (2021). Neurological manifestations of patients with mild-to-moderate COVID-19 attending a public hospital in Lima, Peru. eNeurologicalSci, 23, 100338.
Chou, S. H., Beghi, E., Helbok, R., Moro, E., Sampson, J., Altamirano, V., Mainali, S., Bassetti, C., Suarez, J. I. & McNett, M. (2021). Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19—A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium. JAMA Network Open, 4, 5, e2112131.
Ciciarelli, M. (2020). Academia Brasileira de Neurologia. Manifestações neurológicas do COVID-19. https://www.abneuro.org.br/post/manifesta%C3%A7%C3%B5es-neurol%C3%B3gicas-do-covid-19
Correia, A. O., Feitosa, P., Moreira, J., Nogueira, S., Fonseca, R. B. & Nobre, M. (2020). Neurological manifestations of COVID-19 and other coronaviruses: A systematic review. Neurology, psychiatry, and brain research, 37, 27–32.
Costa, R., Silva, K. R., Saucedo, S. C. M., Silva, L. A., Crevelari, E. S., Nascimento, W. T. J., Fiorelli, A., Martinelli Filho, M. & Jatene, F. B. (2021). Impacto da Pandemia por COVID-19 nos Procedimentos Cirúrgicos de Dispositivos Cardíacos Eletrônicos Implantáveis em um Centro de Referência Terciário. Arquivo Brasileiro de Cardiologia, 117, 4, 765-769.
Divani, A. A., Andalib, S., Biller, J., Di Napoli, M., Moghimi, N., Rubinos, C. A., Nobleza, C. O., Sylaja, P. N., Toledano, M., Lattanzi, S., McCullough, L. D., Cruz-Flores, S., Torbey, M. & Azarpazhooh, M. R. (2020). Central Nervous System Manifestations Associated with COVID-19. Current neurology and neuroscience reports, 20, 12, 60.
Ebrahimpour, S., Mohseni Afshar, Z., Mohseni, S., Masrour-Roudsari, J., Oladzade, S., Bayani, M. & Babazadeh, A. (2020). Neurologic manifestations in patients with COVID-19: A case report. Caspian journal of internal medicine, 11, 1, 557–560.
Ellul, M. A., Benjamin, L., Singh, B., Lant, S., Michael, B. D., Easton, A., Kneen, R., Defres, S., Sejvar, J. & Solomon, T. (2020). Neurological associations of COVID-19. The Lancet Neurology, 19, 9, 767-783.
Eskandar, E. N., Altschul, D. J., de la Garza Ramos, R., Cezayirli, P., Unda, S. R., Benton, J., Dardick, J., Toma, A., Patel, N., Malaviya, A., Flomenbaum, D., Fernandez-Torres, J., Lu, J., Holland, R., Burchi, E., Zampolin, R., Hsu, K., McClelland, A., Burns, J., Erdfarb, A., … Mehler, M. F. (2021). Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19. Neurology, 96, 11, e1527–e1538.
Espíndola, O. M., Siqueira, M., Soares, C. N., Lima, M. A. S. D., Leite, A. C. C. B., Araujo, A. Q. C., Brandão, C. O. & Silva, M. T. T. (2020). Patients whit Covid-19 and neurological manifestations show undetectable Sars-Cov-2 RNA levels in the cerebrospinal fluid. International Journal of Infectious Diseases, 96, 567-569.
Fearon, C. & Fasano, A. (2021). Parkinson’s disease and the COVID-19 pandemic. Journal of Parkinson’s Disease, 11, 2, 431-444.
Flores-Silva, F. D., García-Grimshaw, M., Valdés-Ferrer, S. I., Vigueras-Hernández, A. P., Domínguez-Moreno, R., Tristán-Samaniego, D. P., Michel-Chávez, A., González-Duarte, A., Vega-Boada, F. A., Reyes-Melo, I., Jiménez-Ruiz, A., Chávez-Martínez, O. A., Rebolledo-García, D., Marché-
Fernández, O. A., Sánchez-Torres, S., García-Ramos, G., Cantú-Brito, C. & Chiquete, E. (2021). Neurologic manifestations in hospitalized patients with COVID-19 in Mexico City. PloS one, 16, 4, e0247433.
Fonseca, G. C. D., Silveira, M. F. P., Guimarães, J. Q., Mota, A. L. & Bezerra, M. A. J. (2021). Atuação da equipe multidisciplinar na reabilitação pós-infecção por SARS-CoV-2. Bionorte, 10, 2.
Garg, R. K. & Paliwal, V. K. (2021). Spectrum of neurological complications following COVID-19 vaccination. Neurological sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 1–38.
Gaujac, C. & Amaral, R. C. (2021). Neurological manifestations and pathophysiological mechanisms of Covid-19. Archives of Health Investigation, 10, 7, 1040-1047.
Godoy-Santín, J., Bravo-Grau, S., Nuñez, F., Aguilar, C., Gutiérrez, D., Miranda, H., Sandoval-Rubio, P., Ramos, B., García A, L., Andresen, M. & Mellado, P. (2021). Neurología hospitalaria y COVID-19: serie de 96 pacientes evaluados en un hospital universitario. Revista medica de Chile, 149, 4, 527–532.
Gomes, A. S., Medeiros Filho, O. B. & Sousa, M. N. A. (2020). Associação entre o COVID-19 e manifestações neurológicas. Brazilian Journal of Development, 6, 11, 88950-88961.
Goss, A. L., Samudralwar, R. D., Das, R. R. & Nath, A. (2021). ANA Investigates: Neurological Complications of COVID-19 Vaccines. Annals of neurology, 89, 5, 856–857.
He, Y., Bai, X., Zhu, T., Huang, J., Zhang, H. (2021). What can the neurological manifestations of COVID-19 tell us: a meta-analysis. Journal of Translational Medicine, 19, 363.
Herman, C., Mayer, K. & Sarwal, A. (2020). Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19. Neurology, 95, 2, 77–84.
Huth, S. F., Cho, S. M., Robba, C., Highton, D., Battaglini, D., Bellapart, J., Suen, J. Y., Li Bassi, G., Taccone, F. S., Arora, R. C., Whitman, G., Fraser, J. F. & Fanning, J. P. (2021). Neurological Manifestations of Coronavirus Disease 2019: A Comprehensive Review and Meta-Analysis of the First 6 Months of Pandemic Reporting. Frontiers in neurology, 12, 664599.
Karim, S. & Karim, Q. A. (2021). Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic. The Lancet, 398, 10317, 2126–2128.
Koralnik, I. J. & Tyler, K. L. (2020). COVID-19: A Global Threat to the Nervous System. Annals of Neurology, 88, 1, 1-11.
Liotta, E. M., Batra, A., Clark, J. R., Shlobin, N. A., Hoffman, S. C., Orban, Z. S. & Koralnik, I. J. (2020). Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Annals of Clinical and Translational Neurology, 7, 11, 2221-2230.
Luigetti, M., Iorio, R., Bentivoglio, A. R., Tricoli, L., Riso, V., Marotta, J., Piano, C., Primiano, G., Zileri Del Verme, L., Lo Monaco, M. R., Calabresi, P. & Gemelli Against Covid-19 Group (2020). Assessment of neurological manifestations in hospitalized patients with COVID-19. European journal of neurology, 27, 11, 2322–2328.
Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., Miao, X., Li, Y. & Hu, B. (2020). Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurology, 77, 6, 683–690.
McAlpine, L. S., Fesharaki-Zadeh, A. & Spudich, S. (2021). Coronavirus disease 2019 and neurodegenerative disease: what will the future bring? Current Opinion in Psychiatry, 34, 2, 177-185.
Medina, M. G., Giovanella, L., Bousquat, A., Mendonça, M. H. M. & Aquino, R. (2020). Atenção primária à saúde em tempos de COVID-19: o que fazer? Caderno de Saúde Pública, 36, 8, e00149720.
Ministério da Saúde (2020). Sistema Único de Saúde (SUS): estrutura, princípios e como funciona, https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/s/sistema-unico-de-saude-sus-estrutura-principios-e-como-funciona
Monte, L. M., Mendes, L. A., Camargo, R. L., Gomes, R. S. S., Silveira, P. H. A., Seyfarth, M. S. C., Cunha, D. M., Oliveira, L. P. R., Silveira, R. e Silveira, G. R. R. A. (2020). Complicações atípicas e características clínico-epidemiológicas do COVID-19: uma revisão integrativa. Revista Eletrônica Acervo Saúde, 46, e3699.
Mota, D. M., Ferreira, P. J. G. & Leal, L. F. (2020). Produção científica sobre a COVID-19 no Brasil: uma revisão de escopo. Revista Visa em Debate, 8, 3, 114-124.
Munhoz, R. P., Pedroso, J. L., Nascimento, F. A., Almeida, S. M., Barsottini, O. G. P., Cardoso, F. E. C. & Teive, H. A. G. (2020). Neurological complications in patients with SARS-CoV-2 infection: a systematic review. Arquivos de Neuro-Psiquiatria, 78, 5, 290-300.
Nascimento, O. J. M. (2020). Complicações neurológicas associadas ao SARS-CoV-2 (COVID-19) no Brasil: Organização do grupo NEUROCOVID-RIO e achados preliminares. Revista Brasileira Neurologia, 56, 2, 5-9.
Organização Mundial da Saúde (2020a). WHO Director-General’s opening remarks at the midia briefing on COVID-19 - 11 March 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Organização Mundial da Saúde (2020b). WHO Coronavirus Disease (COVID-19). Dashboard. https://covid19.who.int/
Pezzini, A. & Padovani, A. (2020). Lifting the mask on neurological manifestations of COVID-19. Nature Reviews Neurology, 16, 636–644.
Prakash, A., Singh, H., Sarma, P., Bhattacharyya, A., Dhibar, D. P., Balaini, N., Shree, R., Goyal, M., Modi, M. & Medhi, B. (2021). nCoV-2019 infection induced neurological outcome and manifestation, linking its historical ancestor SARS-CoV and MERS-CoV: a systematic review and meta-analysis. Scientific reports, 11, 1, 12888.
Puccioni-Sohler, M., Poton, A. R., Franklin, M., Silva, S. J., Brindeiro, R. & Tanuri, A. (2020). Current evidence of neurological features, diagnosis, and neuropathogenesis associated with COVID-19. Revista da Sociedade Brasileira de Medicina Tropical, 53, e20200477.
Rodríguez, N. C., Bandala, C., Carlo, A. V., Mejía, I. I., Manzo, S. G., Cruz, E. Y. H., Chaverri, J. P., Aparicio, L. C. & Ochoa, B. H. (2021). Use of antioxidants for the neuro-therapeutic management of COVID-19. Antioxidants (Basel), 10, 6, 971.
Santos, N. N., Ferreira, M. A., Brazil, S. D. S., Cunha, M. S. D., & Guimarães, B. G. (2021). Sequelas no sistema nervoso central por SARS-CoV-2: uma revisão de literatura. Revista Multidisciplinar em Saúde, 2, 4, 48.
Sarti, T. D., Lazarini, W. S., Fontenelle, L. F. & Almeida, A. P. S. C. (2020). Qual o papel da Atenção Primária à Saúde diante da pandemia provocada pela COVID-19? Epidemiologia e Serviços de Saúde, 29, 2, e2020166.
Sharma, S., Wood, M. & Gulli, G. (2021). COVID-19-associated ischaemic stroke despite use of anticoagulation. BMJ Case Reports, 14, 7, e243741.
Silva, F. S. C. A., Bucur, A., Rosado, S. N., Balhana, S. S. & Meneses-Oliveira, C. M. (2021). Disfunção neurológica associada à COVID-19. Revista Brasileira de Terapia Intensiva, 33, 2, 325.
Sisniega, D. C. & Reynolds, A. S. (2021). Neurologic Assessment & Neuromonitoring in the COVID-19 Pandemic. Practical Neurology, 56-60.
Studart-Neto, A., Guedes, B. F., Tuma, R., Camelo Filho, A. E., Kubota, G. T., Iepsen, B. D., Moreira, G. P., Rodrigues, J. C., Ferrari, M., Carra, R. B., Spera, R. R., Oku, M., Terrim, S., Lopes, C., Passos Neto, C., Fiorentino, M. D., DE Souza, J., Baima, J., DA Silva, T., Moreno, C. … Nitrini, R. (2020). Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital. Arquivos de neuro-psiquiatria, 78, 8, 494–500.
Varatharaj, A., Thomas, N., Ellul, M. A., Davies, N., Pollak, T. A., Tenorio, E. L., Sultan, M., Easton, A., Breen, G., Zandi, M., Coles, J. P., Manji, H., Al-Shahi Salman, R., Menon, D. K., Nicholson, T. R., Benjamin, L. A., Carson, A., Smith, C., Turner, M. R., Solomon, T., … CoroNerve Study Group (2020). Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The lancet. Psychiatry, 7, 10, 875–882.
Verstrepen, K., Baisier, L. & De Cauwer, H. (2020). Neurological manifestations of COVID-19, SARS and MERS. Acta neurologica Belgica, 120, 5, 1051–1060.
Whittaker, A., Anson, M., & Harky, A. (2020). Neurological Manifestations of COVID-19: A systematic review and current update. Acta neurologica Scandinavica, 142, 1, 14–22.
Zirpe, K. G., Dixit, S., Kulkarni, A. P., Sapra, H., Kakkar, G., Gupta, R., Bansal, A. R., Garg, A., Dash, S. K., Gurnani, A., Khan, A., Khatib, K. I. & Mare, P. R. (2020). Pathophysiological Mechanisms and Neurological Manifestations in COVID-19. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 24, 10, 975–980.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Luis Felipe Silveira Mega; Fernanda Odete Souza Rodrigues; Júlia Silva Contaifer; Carlos Alberto Cavalcante Junior; Laura de Vasconcelos Machado; Aline Cristina da Silveira; Isadora Dantas Sakr Khouri; Robertha Muszkat; João Luiz Megale de Campos Lomas; Valnice Machado Portela; Ana Paula Sampaio Ferreira Santos Magalhães; Marylia Skarlatti da Silva Souza; Bianca Marçal Kós; Myriam Dantas Pereira; André Faraco de Andrade Alves; Victória Freitas de Souza Moura; Tássia Cristina Duarte
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
