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 |