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1.
Journal of Neurology, Neurosurgery & Psychiatry ; 92(9):932-941, 2021.
Article in English | APA PsycInfo | ID: covidwho-1756020

ABSTRACT

There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations. We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence. 13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n = 15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n = 221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n = 21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n = 13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n = 66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n = 43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n = 64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n = 42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n = 49 326, 19 studies). Heterogeneity for most clinical manifestations was high.Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic's early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308461

ABSTRACT

Background: Pre-existing diseases are considered risk factors for severe COVID-19 and death. However, there is lack of consolidated global data on this risk among individuals with pre-existing neurological disease.Aim: Investigate the impact of pre-existing neurological disease on the clinical course and outcome of COVID-19.Methods: A rapid review of literature from PubMed and the World Health Organization (WHO) COVID-19 database was conducted for articles published between 1st January 2020 and 4th April 2021. The review included individuals with COVID-19 and pre-existing neurological disease using pre-generated search terms to capture chronic neurological diseases in all age-groups. Articles included in the review were systematic reviews and meta-analysis, cohort studies, retrospective studies, case-control studies and case series. From the included studies, demographic data and Odds Ratios (OR) were extracted, and pooled ORs were generated for the outcomes of COVID-19 severity and death.Results: Twenty-six articles from 12 countries across three continents with a total of 379,947 COVID-19 patients was included. The mean age was 57 years (SD 10.93), 51.3% of whom were female. Pre-existing neurological disease, particularly cerebrovascular disease and dementia, was shown to be a risk factor for severe COVID-19 with a pooled OR of 1.99 (1.81 – 2.18). There was also an increased risk of death with a pooled OR for pre-existing neurological disease overall of 1.74 (1.56 – 1.94).Conclusion: The findings suggest that pre-existing neurological disease is a significant risk factor for severe COVID-19 and mortality. Further investigations to consolidate these findings are required through large multi-national cohort studies.

3.
Neurology ; 97(23): e2269-e2281, 2021 12 07.
Article in English | MEDLINE | ID: covidwho-1463290

ABSTRACT

BACKGROUND AND OBJECTIVES: One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality. METHODS: We searched PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE for studies from December 31, 2019, to December 15, 2020, enrolling consecutive patients with COVID-19 presenting with neurologic manifestations. Risk of bias was examined with the Joanna Briggs Institute scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% confidence intervals (CIs) were calculated for neurologic manifestations. Odds ratio (ORs) and 95% CIs were calculated to determine the association of neurologic manifestations with disease severity and mortality. Presence of heterogeneity was assessed with I 2, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2. RESULTS: Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 patients with COVID-19, 89% of whom were hospitalized. Forty-one neurologic manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurologic symptoms included fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%), and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurologic diagnosis (pooled prevalence 2%). In patients with COVID-19 ≥60 years of age, the pooled prevalence of acute confusion/delirium was 34%, and the presence of any neurologic manifestations in this age group was associated with mortality (OR 1.80, 95% CI 1.11-2.91). DISCUSSION: Up to one-third of patients with COVID-19 analyzed in this review experienced at least 1 neurologic manifestation. One in 50 patients experienced stroke. In those >60 years of age, more than one-third had acute confusion/delirium; the presence of neurologic manifestations in this group was associated with nearly a doubling of mortality. Results must be interpreted with the limitations of observational studies and associated bias in mind. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020181867.


Subject(s)
COVID-19/epidemiology , Delirium/epidemiology , Stroke/epidemiology , COVID-19/complications , COVID-19/mortality , Delirium/complications , Delirium/mortality , Humans , Observational Studies as Topic , SARS-CoV-2/pathogenicity , Stroke/complications
4.
J Stroke Cerebrovasc Dis ; 30(9): 105915, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1253282

ABSTRACT

We report the case of a 35-year-old male with COVID-19 encephalitis presenting as a stroke mimic with sudden-onset expressive and receptive dysphasia, mild confusion and right arm incoordination. The patient received thrombolysis for a suspected ischaemic stroke, but later became febrile and SARS-CoV-2 was detected in cerebrospinal fluid. Electroencephalography demonstrated excess in slow waves, but neuroimaging was reported as normal. Respiratory symptoms were absent throughout and nasopharyngeal swab was negative for SARS-CoV-2. At the most recent follow-up, the patient had made a full neurological recovery. Clinicians should therefore consider testing for SARS-CoV-2 in CSF in patients who present with acute focal neurology, confusion and fever during the pandemic, even when there is no evidence of respiratory infection.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Encephalitis, Viral/diagnosis , Ischemic Stroke/diagnosis , RNA, Viral/cerebrospinal fluid , SARS-CoV-2/genetics , Adult , COVID-19/cerebrospinal fluid , COVID-19/virology , Diagnosis, Differential , Electroencephalography , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/virology , Humans , Magnetic Resonance Imaging , Male , Predictive Value of Tests , Tomography, X-Ray Computed
5.
Front Neurol ; 12: 637586, 2021.
Article in English | MEDLINE | ID: covidwho-1110314
7.
Neurosci Lett ; 741: 135491, 2021 01 10.
Article in English | MEDLINE | ID: covidwho-1071804

ABSTRACT

Historical epidemiological perspectives from past pandemics and recent neurobiological evidence link infections and psychoses, leading to concerns that COVID-19 will present a significant risk for the development of psychosis. But are these concerns justified, or mere sensationalism? In this article we review the historical associations between viral infection and the immune system more broadly in the development of psychosis, before critically evaluating the current evidence pertaining to SARS-CoV-2 and risk of psychosis as an acute or post-infectious manifestation of COVID-19. We review the 42 cases of psychosis reported in infected patients to date, and discuss the potential implications of in utero infection on subsequent neurodevelopment and psychiatric risk. Finally, in the context of the wider neurological and psychiatric manifestations of COVID-19 and our current understanding of the aetiology of psychotic disorders, we evaluate possible neurobiological and psychosocial mechanisms as well as the numerous challenges in ascribing a causal pathogenic role to the infection.


Subject(s)
COVID-19/complications , COVID-19/diagnosis , Delusions/diagnosis , Delusions/etiology , Psychotic Disorders/diagnosis , Psychotic Disorders/etiology , Adolescent , Adult , COVID-19/psychology , Delusions/psychology , Female , Humans , Male , Middle Aged , Psychotic Disorders/psychology , Risk Factors , Young Adult
9.
Lancet Neurol ; 19(9): 767-783, 2020 09.
Article in English | MEDLINE | ID: covidwho-626383

ABSTRACT

BACKGROUND: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is of a scale not seen since the 1918 influenza pandemic. Although the predominant clinical presentation is with respiratory disease, neurological manifestations are being recognised increasingly. On the basis of knowledge of other coronaviruses, especially those that caused the severe acute respiratory syndrome and Middle East respiratory syndrome epidemics, cases of CNS and peripheral nervous system disease caused by SARS-CoV-2 might be expected to be rare. RECENT DEVELOPMENTS: A growing number of case reports and series describe a wide array of neurological manifestations in 901 patients, but many have insufficient detail, reflecting the challenge of studying such patients. Encephalopathy has been reported for 93 patients in total, including 16 (7%) of 214 hospitalised patients with COVID-19 in Wuhan, China, and 40 (69%) of 58 patients in intensive care with COVID-19 in France. Encephalitis has been described in eight patients to date, and Guillain-Barré syndrome in 19 patients. SARS-CoV-2 has been detected in the CSF of some patients. Anosmia and ageusia are common, and can occur in the absence of other clinical features. Unexpectedly, acute cerebrovascular disease is also emerging as an important complication, with cohort studies reporting stroke in 2-6% of patients hospitalised with COVID-19. So far, 96 patients with stroke have been described, who frequently had vascular events in the context of a pro-inflammatory hypercoagulable state with elevated C-reactive protein, D-dimer, and ferritin. WHERE NEXT?: Careful clinical, diagnostic, and epidemiological studies are needed to help define the manifestations and burden of neurological disease caused by SARS-CoV-2. Precise case definitions must be used to distinguish non-specific complications of severe disease (eg, hypoxic encephalopathy and critical care neuropathy) from those caused directly or indirectly by the virus, including infectious, para-infectious, and post-infectious encephalitis, hypercoagulable states leading to stroke, and acute neuropathies such as Guillain-Barré syndrome. Recognition of neurological disease associated with SARS-CoV-2 in patients whose respiratory infection is mild or asymptomatic might prove challenging, especially if the primary COVID-19 illness occurred weeks earlier. The proportion of infections leading to neurological disease will probably remain small. However, these patients might be left with severe neurological sequelae. With so many people infected, the overall number of neurological patients, and their associated health burden and social and economic costs might be large. Health-care planners and policy makers must prepare for this eventuality, while the many ongoing studies investigating neurological associations increase our knowledge base.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Nervous System Diseases/diagnostic imaging , Nervous System Diseases/epidemiology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Animals , COVID-19 , Coronavirus Infections/diagnosis , Humans , Nervous System Diseases/virology , Pandemics , SARS-CoV-2 , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/epidemiology
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