Meta-analysis/systematic review (Red)
Coronavirus disease-2019.(COVID-19) has been associated with various neurological and atypical HEENT (head/eyes/eyes/nose/throat) manifestations. In this systematic review and meta-analysis the authors sought to review the evidence for these manifestations. 477 studies were included for qualitative synthesis and 59 studies for meta-analyses. Anosmia, ageusia, and conjunctivitis may precede typical upper/lower respiratory symptoms. CNS manifestations include stroke and encephalopathy, potentially with brainstem or cranial nerve involvement. MRI studies support CNS para-/post-infectious etiologies, but direct neuro-invasion seems very rare, with few cases detecting SARS-CoV-2 in the CNS. PNS manifestations include muscle damage, Guillain-Barre syndrome.(GBS), and its variants. There was moderate-to-high study heterogeneity and risk of bias. In random-effects meta-analyses, anosmia/ageusia was estimated to occur in 56% of COVID-19 patients (95%CI:0.41-0.71, I2:99.9%), more commonly than in patients without COVID-19 (OR:14.28, 95%CI:8.39-24.29, I2:49.0%). Neurological symptoms were estimated to occur in 36% of hospitalized patients (95%CI:0.31-0.42, I2:99.8%); ischemic stroke in 3%.(95%CI:0.03-0.04, I2:99.2%), and GBS in 0.04%.(0.033-0.047%), more commonly than in patients without COVID-19 (OR[stroke]:2.53, 95%CI:1.16-5.50, I2:76.4%; OR[GBS]:3.43,1.15-10.25, I2:89.1%). The authors concluded that current evidence is mostly from retrospective cohorts or series, largely in hospitalized or critically ill patients, not representative of typical community-dwelling patients. There remains a paucity of systematically gathered prospective data on neurological manifestations. Nevertheless, these findings support a high index of suspicion to identify HEENT/neurological presentations in patients with known COVID-19, and to test for COVID-19 in patients with such presentations at risk of infection.
Ganesh A, Reis IR, Varma M, Patry DG, Cooke LJ. Neurological and HEENT Manifestations of COVID-19: A Systematic Review and Meta-Analysis. Can J Neurol Sci. 2021 Jul 21:1-43. doi: 10.1017/cjn.2021.180.