by Dr. Juliette Dufour
For February 2022, we have selected: S. Misra et al, Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis. Neurology. 2021 Dec 7;97(23):e2269-e2281. DOI: https://doi.org/10.1212/WNL.0000000000012930.
One year into the coronavirus disease 2019 (COVID-19) pandemic, the disease caused 202 million cases and 4.28 million deaths across 220 countries up to August 9, 2021. Prior systematic reviews have highlighted the frequency of common neurologic symptoms observed in COVID-19, including fatigue, myalgia, impaired sense of smell or taste, and headaches. Additional neurologic manifestations reported acute confusion/delirium, agitation, stroke, hypoxic ischaemic injury, seizures, coma, and encephalitis, among others. However, considerable variations in the frequency of neurologic manifestations have been reported.
Our authors of the month conducted a systematic review and meta-analysis in order to summarise the frequency of neurologic manifestations in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.
They included studies that presented patients with COVID-19 and neurologic manifestations found on PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE from 31 December, 2019, to 15 December, 2020.
In total, 350 studies from 55 countries were included with 145,721 patients with COVID-19. Of those, 51% were male, and 89% were hospitalised. The main pre-existing comorbid conditions were hypertension (26%), diabetes (14%) and cardiovascular/cerebrovascular disease (18%).
41 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%). Stroke was the most common neurologic diagnosis (pooled prevalence 2% over 29 studies). The pooled prevalence of neuropsychiatric disorders was 24% over three studies, and 5% for skeletal muscle injury.
Regarding the association of these manifestations and severity, patients with severe COVID-19 were less likely than those with mild disease to have alterations in smell and taste. No other significant association was found.
The pooled prevalence of mortality in patients with COVID-19 with ≥1 neurologic manifestations was 27% (95% CI 19%–35%). There was a nonsignificant trend toward higher odds of mortality in patients with neurologic manifestations compared to those without them (OR 1.39, 95% CI 0.92–2.11). 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).
Our authors of the month concluded that one third of patients with COVID-19 experienced at least one neurologic manifestation and 1 in 50 people developed a stroke. Moreover, their analysis shows age and severity as predictors of neurologic findings. Therefore, neurologic manifestations may be factored into risk stratification, especially for older persons with COVID-19, given the association with higher mortality for any neurologic manifestation in this subpopulation.