Table 1 The characteristics of included systematic reviews regarding the general manifestations of COVID-19 infection
From: Neurological manifestations of COVID-19 infection: an umbrella review
Authors | Origin | Type | Quality | Number of included studies | Types of included studies | Assessing the quality of included studies | Searched databases | Main results |
|---|---|---|---|---|---|---|---|---|
1. Whittaker et al. 2020 [25] | UK | Systematic review | Critically Low | 31 | Cohort, case report, cross-sectional, case–control | None | Pubmed, Embase, Scopus, Google Scholar, Cochrane Library, Ovid | Headache and anosmia were the most common neurological manifestations of SARS-CoV-2 in hospitalized patients. Less common symptoms include seizure, stroke and isolated cases of GBS1 |
2. Wang et al. 2020 [18] | China | Systematic review + meta-analysis | Critically Low | 41 | Case series, case report, cross-sectional, case–control, letters | NIH2 quality assessment tool | Pubmed, Embase, Scopus, medRxiv, bioRvix | The most common manifestationswere fatigue, anorexia, dyspnea/shortness of breath, and malaise. The common specific neurological symptoms included OGD3, especially in mild cases. GBS and acute inflammation of the brain, spinal cord, and meninges |
3. Chen et al. 2020 [20] | Germany | Systematic review | Moderate | 92 | Cohort, case series, case report, case–control, letters | 1. Criteria for diagnosis of Covid-192. Laboratory confirmation method 3. The respiratory specimens used for testing | Pubmed, medRxiv, bioRxiv, Three Chinese databases | Headache, dizziness, taste and smell dysfunctions, and impaired consciousness were the most frequently described neurological symptoms |
4. Neishaboori et al. 2020 [15] | Iran | Systematic review + meta-analysis | Moderate | 7 | Cohort, case series, case–control | NHLBI4 quality assessment tool | Pubmed, Embase, Scopus, Web of Science | The most common type of CNS5 complications included encephalopathy and acute cerebrovascular disease |
5. Di Carlo et al. 2020 [21] | Italy | Systematic review | Moderate | 19 | Cohort, case series, case report, case–control | Modified NOS6 | Pubmed, Embase | Headache, dizziness, OGD were reported in patients, three studies reported radiological confirmed acute cerebrovascular disease |
6. Asadi-Pooya et al. 2020 [26] | Iran | Systematic review | Critically Low | 8 | Cohort, case series, case report | None | Pubmed, Scopus | Nonspecific neurological symptoms, such as confusion and headache were reported in COVID-19 patients. A few patients also showed more specific manifestations, such as seizure or cerebrovascular problems |
7. Nepal et al. 2020 [28] | Nepal | Systematic review | Critically Low | 37 | Cohort, case series, case report, case–control | None | Pubmed, Google Scholar, Chinese National Knowledge Infrastructure, Research square, medRxiv, Social Science Research Network, and ChinaXiv | The most commonly reported neurological manifestations of COVID-19 weremyalgia, headache, altered sensorium and OGD. Uncommonly, COVID-19 can also present with CNS manifestations such as ischemic stroke, intracerebral hemorrhage, encephalo-myelitis, and acute myelitis, PNS7 manifestations such as GBS and Bell’s palsy, and skeletal muscle manifestations such as rhabdomyolysis are also reported |
8. Taherifard et al. 2020 [27] | Iran | Systematic review | Critically Low | 22 | Case series, case report | None | Pubmed, Scopus, Web of Science | The virus seemed to affect both PNS and CNS. The most frequently reported neurological complication was acute ischemic cerebrovascular accident, followed by GBS syndrome |
9. Ghannam et al. 2020 [31] | USA | Systematic review | Moderate | 42 | Case series, case report | JBI8 Critical Appraisal Tool | Pubmed, Ovid Medline | COVID-19 patients demonstrated cerebrovascular insults, neuromuscular disorders, and encephalitis or encephalopathy |
10. Abdullahi et al. 2020 [11] | Nigeria | Systematic review + meta-analysis | Moderate | 60 | Cohort, case series, case report, cross-sectional, case–control | Modified McMaster critical review form | Pubmed, Embase, Google Scholar, Web of Science | The most common type of neurological and musculoskeletal manifestations were as followed: OGD, myalgia, headache, back pain, dizziness, acute cerebrovascular disease and impaired consciousness |
11. Cagnazzo et al. 2020 [19] | France | Systematic review | Moderate | 39 | Case series, case–control | Modified NOS | Pubmed, Embase, Scopus | Headache, muscle injury, psychiatric involvement, impaired consciousness, OGD, acute cerebrovascular events and dizziness were the most frequently reported neurological manifestations. Less common ones were ischemic stroke, cranial nerve impairment, nerve root and plexus disorders, epilepsy, and hemorrhagic stroke |
12. Collantes et al. 2020 [13] | Philippines | Systematic review + meta-analysis | High | 35 | Cohort, case series, case report, case–control | Murad tool | Pubmed, Embase, Scopus, WHO database | The most common type of neurological involvements were headache, dizziness, headache and dizziness, nausea, vomiting, nausea and vomiting, confusion and myalgia. The most common neurological complication associated with COVID-19 was vascular disorders; others included encephalopathy, encephalitis, oculomotor nerve palsy, isolated sudden-onset anosmia, GBS, and Miller–Fisher syndrome |
13. Orrù et al. 2020 [22] | Italy | Systematic review | Critically Low | 87 | Cohort, case report, case–control, in-press articles | None | Pubmed, Scopus | OGD, ischemic/hemorrhagic stroke, meningoencephalitis and encephalopathy, including acute necrotizing encephalopathy were commonly associated with COVID-19; PNS involvements included, GBS and Miller Fisher syndromes |
14. Favas et al. 2020 [14] | India | Systematic review + meta-analysis | High | 212 | Cohort, experimental, case report, cross-sectional, case–control, letters | NOS, CONSORT9 | Pubmed, Embase, Scopus, Google Scholar, Cochrane Library, Web of Science, WHO database, EBSCO, Clinicaltrial.gov | OGD, myalgia, headache, dizziness, and syncope are reported in COVID-19. Ischemic stroke, followed by hemorrhagic stroke, and cerebral venous thrombosis were also reported |
15. Munhoz et al. 2020 [29] | Brazil | Systematic review | Critically Low | 43 | Cohort, experimental, case series, case report, case–control | None | Pubmed, LILACS | Non-specific symptoms, such as hyposmia and myalgia, to more complex and life-threatening conditions, such as cerebrovascular diseases, encephalopathies, and GBS are associated with COVID-19 infection |
16. Romoli et al. 2020 [23] | Italy, Austria, Zurich, Switzerland | Systematic review | Moderate | 27 | Cohort, case series, case report, cross-sectional, case–control | NOS | Pubmed, Embase, Google Scholar, medRxiv, ChinaXiv | Cases of OGD, GBS, Miller-Fisher syndrome, cranial neuropathy, meningitis, encephalitis, and various other conditions were linked to COVID-19 |
17. Pinzon et al. 2020 [16] | Indonesia | Systematic review + meta-analysis | Moderate | 33 | Cohort, experimental, case report, ross-sectional, case–control | The Oxford CEBM12 | Pubmed | Myalgia was the most common, neurologic symptom of COVID-19, followed by headache, dizziness; nausea with or without vomiting; concurrent cerebrovascular disease; and impaired consciousness |
18. Chua et al. 2020 [12] | Singapore | Systematic review + meta-analysis | Critically Low | 48 | Cohort, case series, case report, cross-sectional, case–control, letters, rapid comments | None | Pubmed, Google Scholar | Stroke is the most frequently reported neurological manifestation in COVID-19 and has the highest mortality rate. Other manifestations included GBS and variants, meningitis, encephalitis, encephalopathy, myelitis and seizures |
19. Scoppettuolo et al. 2020 [24] | Switzerland, Belgium | Systematic review | Critically Low | 42 | Case series, case report | None | Pubmed, Scopus, Cochrane Library | Neurological complications of SARS-CoV-2 are mainly related to OGD, cerebrovascular disease and PINS10 are rare |
20. Tsai et al. 2020 [17] | Taiwan | Systematic review + meta-analysis | Critically Low | 79 | Case series, case report | None | Pubmed, Embase, Cochrane Library | OGD, myalgia, headache, acute cerebral vascular disease, dizziness, altered mental status, seizure, encephalitis, neuralgia, ataxia, GBS, Miller Fisher syndrome, intracerebral hemorrhage, polyneuritis cranialis, and dystonic posture were demonstrated in COVID-19 patients |
21. Ibrahim 2020 [30] | Egypt | Systematic review | Critically Low | 20 | Cohort, experimental, case series, case report, cross-sectional | None | Pubmed, Scopus, Cochrane Library, clinicaltrials.gov | CNS symptoms was more common compared to the PNS. Headache was the most common neurological symptoms in regard to number of patients, meanwhile dizziness had the highest incidence |