TY - JOUR
T1 - Frequency of neurologic manifestations in COVID-19
AU - Misra, Shubham
AU - Kolappa, Kavitha
AU - Prasad, Manya
AU - Radhakrishnan, Divya
AU - Thakur, Kiran T.
AU - Solomon, Tom
AU - Michael, Benedict Daniel
AU - Winkler, Andrea Sylvia
AU - Beghi, Ettore
AU - Guekht, Alla
AU - Pardo, Carlos A.
AU - Wood, Greta Karen
AU - Chou, Sherry Hsiang Yi
AU - Fink, Ericka L.
AU - Schmutzhard, Erich
AU - Kheradmand, Amir
AU - Hoo, Fan Kee
AU - Kumar, Amit
AU - Das, Animesh
AU - Srivastava, Achal K.
AU - Agarwal, Ayush
AU - Dua, Tarun
AU - Prasad, Kameshwar
N1 - Publisher Copyright:
Copyright © 2021 American Academy of Neurology.
PY - 2021/12/7
Y1 - 2021/12/7
N2 - 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 I2, 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.
AB - 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 I2, 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.
UR - http://www.scopus.com/inward/record.url?scp=85119511689&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85119511689&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000012930
DO - 10.1212/WNL.0000000000012930
M3 - Review article
C2 - 34635561
AN - SCOPUS:85119511689
SN - 0028-3878
VL - 97
SP - E2269-E2281
JO - Neurology
JF - Neurology
IS - 23
ER -