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Table 2 General signs and symptoms, and associated neurological manifestations reported in the studies on COVID-19 infected patients

From: Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

  Article name Article type N = no. of patients Age/sex General signs and symptoms Neurological manifestations
1 A case of COVID-19 respiratory illness with subsequent seizure and hemiparesis [9] Case report 1 38-year-old male Progressive cough
Fever
Dyspnea
Generalized tonic—clonic seizure (GTCS)
Left-sided hemiplegia
Decreased right side spontaneous movements
2 A case series of devastating intracranial hemorrhage during venovenous extracorporeal membrane oxygenation for COVID-19 [3] Case series 4 Mean age—50.7 years   Anisocoria
Gaze defect
Altered mental status (AMS)
Agitation
3 A first case of meningitis/encephalitis associated with SARS-coronavirus-2 [10] Case report 1 24-year-old male Headache
Generalized fatigue
Fever and sore throat
Neck stiffness
Transient generalized seizures
Glasgow coma scale (GCS)—6/15
4 Acute abducens nerve palsy in a patient with the novel coronavirus disease (COVID-19) [11] Case report 1 32-year-old male Fever and cough
Diarrhea
Fatigue
Diplopia (acute, binocular, horizontal)
5 Acute disseminated encephalomyelitis after SARS-CoV-2 infection [12] Case report 1 64-year-old female Influenza-like syndrome Anosmia, ageusia
B/L vision impairment
Right leg sensory deficit
6 Acute myelitis as a neurological complication of COVID-19: a case report and MRI findings [13] Case report 1 32-year-old male Flu-like symptoms Urinary retention
B/L lower limb weakness
7 Acute polyradiculoneuritis with locked-in syndrome in a patient with COVID-19 [14] Letter to the editor 1 51-year-old male Flu-like symptoms Progressive upper and lower limb weakness
Acral paresthesia
8 Acute profound sensorineural hearing loss after COVID-19 pneumonia [15] Correspondence (case report) 1 60-year-old male Fever with cough Sensorineural hearing loss
9 Basal ganglia involvement and altered mental status: a unique neurological manifestation of coronavirus disease 2019 [16] Case report 1 54-year-old female Low-grade fever
Cough
AMS
GCS- 10/15
10 Bilateral posterior cerebral artery territory infarction in a SARS-Cov-2 infected patient: discussion about an unusual case [17] Case report 1 51-year-old male Cough
Diarrhea
Headache
Dysgeusia
Abrupt cortical blindness
Disorientation
11 Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection [18] Case report 1 69-year-old male Fever
Abdominal pain
Left posterior chest pain
Binocular diplopia
Severe stabbing occipital headache
Bilateral paresis of CN IV
12 Cerebral microhemorrhage and purpuric rash in COVID-19: The case for a secondary microangiopathy [19] Case report 1 69-year-old male Dyspnea, cough
Diarrhea
Fever
Diffuse rash
Deterioration of mental status
13 Cerebral nervous system vasculitis in a COVID-19 patient with pneumonia [20] Case report 1 64-year-old male Fever
Cough
Tetraplegia and B/L mute plantar response
GCS- 6/15
14 Cerebral venous thrombosis: a typical presentation of COVID-19 in the young [21] Case report 1 25-year-old female Cough
Low-grade fever
Mild shortness of breath
GTCS with post-ictal confusion
Decreased level of arousal
Global aphasia
Right facial nerve palsy
B/L CN VI palsy
15 Coexistence of COVID-19 and acute ischemic stroke report of four cases [22] Case report 4 45-year-old female
67-year-old female
72-year-old male
77-year-old male
Fever
Cough
Shortness of breath
Left facial paresis
Dysarthria
Hemiparesis
Loss of consciousness
Mild ataxia
Left hemi-hypoesthesia
16 Concomitant neurological symptoms observed in a patient diagnosed with coronavirus disease 2019 [23] Case report 1 64-year-old male Fever with mild cough
Insomnia
Muscle soreness
Poor mental state
B/L ankle clonus, Left Babinski sign +
Neck Stiffness with Brudzinski sign +
17 Coronavirus 2019 (COVID-19)-associated encephalopathies and cerebrovascular disease: the New Orleans experience [24] Retrospective cohort study 27 Mean age—59.8 years   Altered mental status
Headache
Dysgeusia
Gaze deviation
Focal deficits
Hemiparesis/hemiplegia
18 COVID-19 presenting as stroke [25] Case series 4 73-year-old male
83-year-old male
80-year-old female
88-year-old female
Fever
Respiratory distress
Nausea/vomiting
Reduced oral intake
Altered mental status
Facial drop
Slurred speech
Left-sided hemiparesis
Right-arm weakness
Word-finding difficulty
19 COVID-19 presenting with seizures [26] Case report 1 72-year-old male Weakness, lightheadedness after a hypoglycemic episode
Shortness of breath
AMS
Multiple episodes of tonic—clonic movements of upper and lower limbs
20 COVID-19 related neuroimaging findings: a signal of thromboembolic complications and a strong prognostic marker of poor patient outcome [27] Retrospective cohort study 454 Median age—64 years   AMS/delirium (37.6%)
Stroke (17.3%)
Mechanical fall/ trauma (25.5%)
Syncope (4%)
Headache (3.8%)
Dizziness (2.8%)
Seizure (2.1%)
Ataxia (1.4%)
21 COVID-19-associated encephalopathy with fulminant cerebral vasoconstriction: CT and MRI findings [28] Case report 1 50-year-old male Fatigue
Nausea
Vomiting
Severe headache
Worsening lethargy
Fixed mydriasis with deviation toward the left
22 COVID-19-associated encephalopathy: neurological manifestation of COVID-19 [29] Case report 1 43-year-old male Fever, dry cough
Generalized weakness
Decreased level of consciousness
GCS- 3/15
23 COVID-19-associated ophthalmoparesis and hypothalamic involvement [30] Case report 2 60-year-old female
35-year-old female
Patient 1. Fever
Nausea
Cough
Patient 2. History of vomiting
Patient 1. Right CN VI palsy
Hyposmia
Right hemi-cranial headache
Diplopia
Patient 2. Diplopia
Paresthesia
Decreased arousal
Disorientation
Episodic memory deficits
B/L CN VI palsy
Mild paraparesis
24 COVID-19-associated pulmonary and cerebral thromboembolic disease [31] Case report 1 79-year-old female   Aphasia
Left hemiparesis
25 COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia [32] Case report 1 59-year-old female Sore throat
Shortness of breath
Myalgia
Vomiting
Episodes of vacant staring
Speech arrest
Flexion of both shoulders
GTCS with post-ictal reduced consciousness
26 COVID-19-related strokes in adults below 55 years of age: a case series [33] Case series 6 33-year-old female
39-year-old male
40-year-old male
47-year-old female
49-year-old female
53-year-old male
Cough
Dyspnea
Myalgia
Lethargy
Headache
Altered consciousness
Global aphasia
Hemiplegia
Left side weakness
Homonymous hemianopia
Sensory deficit
Dysarthria
27 COVID-19-associated encephalitis mimicking glial tumor [34] Case report 1 35-year-old female Headache
Nausea
Drug-refractory seizures
Dizziness
28 De novo status epilepticus in patients with COVID-19 [35] Case series 2 49-year-old female
73-year-old female
Patient 1. None
Patient 2. Shortness of breath
Lower limb edema
Patient 1. B/L tonic clonic seizures
Altered mental status
Patient 2. Face and arm myoclonus
Altered mental status
29 Delirium as a presenting feature in COVID-19: neuroinvasive infection or autoimmune encephalopathy? [36] Case report (letter to the editor) 2 46-year-old male
79-year-old female
  Patient 1. Status epilepticus
Acute hypoactive delirium
Disinhibition
Headache
Patient 2. Generalized seizure
Dysphasia
Impaired orientation, attention and memory
30 Emergency room neurology in times of COVID-19: malignant ischaemic stroke and SARS-CoV-2 infection [7] Case report 1 36-year-old female Unconsciousness Global aphasia
Right hemiplegia
31 Encephalopathy and seizure activity in a COVID-19 well controlled HIV patient [37] Case report 1 41-year-old male Abdominal pain
Intractable vomiting
Dry cough
Intermittent fever
Confusion and agitation
GTCS
Left-sided ptosis
32 COVID-19-associated myositis with severe proximal and bulbar weakness [38] Case report (letter to the editor) 1 58-year-old female Cough
Dyspnea
Myalgia with severe generalized weakness
Dysphagia
Odynophagia
Proximal bulbar weakness
Bilateral ptosis
Facial weakness
Hypernasal dysarthria
Profound symmetric proximal limb weakness
33 Evolution and resolution of brain involvement associated with SARS-CoV2 infection: a close clinical—paraclinical follow up study of a case [39] Case report 1 39-year-old female Fever with dry cough
Myalgias and anorexia
Decline in consciousness
Multiple episodes of GTCS
34 First case of focal epilepsy associated with SARS-coronavirus-2 [40] Case report 1 73-year-old female Fatigue
Dry cough
Back pain
Painful muscle stiffening and twitching in the left leg and arm (focal seizure)
35 First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease [41] Case report 1 42-year-old female Mild respiratory symptoms Paresthesia and hypoesthesia in left upper limb, left hemithorax, and hemiface
36 First motor seizure as presenting symptom of SARS-CoV-2 infection [42] Case report 1 54-year-old male Conjunctivitis
Fever
Clonic movements in the right arm
Loss of consciousness
37 Focal EEG changes indicating critical illness associated cerebral microbleeds in a COVID-19 patient [43] Case report 1 56-year-old female Cough
Fever
Agitation
Impaired cognition and vigilance
Executive dysfunction
38 Fulminant cerebral edema as a lethal manifestation of COVID-19 [44] Case report 1 57-year-old male Fatigue and fever
Dyspnea
Nausea/vomiting
Diarrhea
Dilated and nonreactive pupils
Absent brain stem reflexes
39 Intracranial hemorrhage in a young COVID-19 patient [45] Case report 1 42-year-old male Severe cough
Fever (103°F)
Dyspnea
Pleuritic chest pain
U/L pupillary changes- progressed to B/L fixed and dilated pupils
Loss of all brain stem reflexes
40 Ischemic stroke associated with novel coronavirus 2019: a report of three cases [46] Case reports 3 88-year-old female
85-year-old female
55-year-old male
Fever
Dry cough
Asthenia
Ataxia
Dysarthria
Impaired orientation
Drowsiness
Peripheral/central facial paresis
Limb weakness
Impaired memory
Acute hemiplegia
Broca’s aphasia
41 Locked-in with COVID-19 [47] Case report 1 25-year-old female Cough
Shortness of breath
Fever
Malaise
Unable to exhibit motor functions
Only able to follow commands through horizontal eye movement and eye blinking
B/L Babinski sign +
42 Macrothrombosis and stroke in patients with mild COVID-19 infection [48] Case report 3 33-year-old female
77-year-old female
55-year-old male
Cough Patient 1—Left sided hemiplagia with hemisensory loss
Patient 2—Sudden onset aphasia with left side hemiparesis
Patient 3—Left sided weakness
43 Malignant cerebral ischemia in a COVID-19 infected patient: case review and histopathological findings [49] Case report 1 48-year-old male Dyspnea
Cough
Left-sided hemiplegia and neglect
Speech abnormalities
44 Multiple sclerosis following SARS-CoV-2 infection [50] Case report 1 29-year-old female Anosmia, dysgeusia
Asthenia
Reduced visual acuity in right eye
Eye movements associated with increased retro-ocular pain and color desaturation
Pyramidal tract dysfunction
45 Necessity of brain imaging in COVID-19 infected patients presenting with acute neurological deficits [51] Case study 2 37-year-old female
47-year-old female
Patient 1. Fever, cough
Shortness of breath
Patient 2. Lethargy
AMS
46 Neuralgic amyotrophy following infection with SARS-CoV-2 [52] Case report 1 52-year-old male Rhinorrhea
Headache
Persistent severe pain in the right shoulder aggravated by arm extension with gradual shift to forearm and hand
Paresthesia of index and long fingers
Progressive weakness of right hand
47 Neurological manifestations in critically ill patients with COVID-19: a retrospective study [53] Retrospective case series 7 Mean age—66 ± 11.1 years Fever
Cough
Myalgia
Fatigue
Headache
Dizziness
Delirium
Acute ischemic stroke
Intracerebral hemorrhage
Hypoxic-ischemic brain injury
Flaccid paralysis
48 Novel coronavirus (COVID-19)-associated Guillain-Barré syndrome: case report [54] Case report 1 54-year-old male Rhinorrhea
Odynophagia
Fevers, chills, and night sweats
Ascending limb weakness and numbness
Quadriparesis
Facial diplegia
Mild ophthalmoparesis
49 Olfactory gyrus intracerebral hemorrhage in a patient with COVID-19 infection [55] Case report 1 72-year-old male Anosmia
Loss of appetite
Focal onset status epilepticus with Todd’s paralysis
50 Orbitofrontal involvement in a neuroCOVID-19 patient [56] Case report 1 69-year-old male Cough
Fever
Anosmia
Status epilepticus
51 Posterior reversible encephalopathy syndrome (PRES): another imaging manifestation of COVID-19 [57] Case report 1 59-year-old male Fever
Dyspnea
Encephalopathy
52 Prolonged confusional state as first manifestation of COVID-19 [6] Case report 1 77-year-old male Lethargy Prolonged confusion
53 Reversible cerebral vasoconstriction syndrome and dissection in the setting of COVID-19 infection [58] Case report 1 30s female Severe cough Severe thunderclap headache
54 Reversible encephalopathy syndrome (PRES) in a COVID-19 patient [59] Case report 1 64-year-old female Fever
Dyspnea
Drowsiness
Blurred vision
AMS
Decreased left nasolabial fold
Decreased strength and tone in B/L lower limbs
DTRs decreased
55 SARS-CoV-2-associated Guillain-Barré syndrome with dysautonomia [60] Letter to the editor 1 72-year-old male Mild diarrhea
Anorexia
Chills
Symmetric paresthesia
Ascending appendicular weakness
Tendon reflexes- absent
Diminished sensation to light touch
SIADH and Dysautonomia
56 Severe headache as the sole presenting symptom of COVID-19 pneumonia: a case report [61] Case reports and case series 1 76-year-old female   Severe generalized headache
Neck pain
57 Steroid-responsive encephalitis in coronavirus disease 2019 [62] Case report 1 60-year-old male Fever
Cough
Asthenia
Cognitive fluctuations
Severe akinetic syndrome associated with mutism
Palmomental and glabella reflexes +
Moderate nuchal rigidity
58 Stroke and COVID-19: not only a large-vessel disease [63] Case report 1 49-year-old female   Dysarthria
Left side hemiparesis, hemianesthesia, and facial weakness
59 Stroke in patients with SARS-CoV-2 infection: case series [64] Retrospective observational case series 6 Median age—69 years Fever
Cough
Dyspnea
Left-sided hemiparesis
B/L fixed and dilated pupils
Loss of consciousness
Confusion
Behavioral abnormalities
60 Subcortical myoclonus in COVID-19: comprehensive evaluation of a patient [65] Case report 1 58-year-old male Fever Cough Dyspnea Myoclonus elicited by action and tactile stimuli predominant in right proximal inferior limb muscles
61 Thalamic perforating artery stroke on computed tomography perfusion in a patient with coronavirus disease 2019 [66] Case report 1 50-year-old male Bilateral pneumonia Sudden right facial palsy
Mild Right limb weakness
62 Two patients with acute meningoencephalitis concomitant with SARS-CoV-2 infection [67] Case report 2 64-year-old female
67-year-old female
Flu-like symptoms Tonic clonic seizures
Headache
Psychotic symptoms
Disorientation with motor perseverations with B/L grasping
Aggressiveness
Left hemianopia
Sensory hemineglect
63 COVID-19 is associated with an unusual pattern of brain microbleeds in critically ill patients [68] Case series 9 Mean age—67.7 years Fever
Cough
Dyspnea
Delayed recovery of consciousness
Psychomotor agitation
Confusion