Neurological Manifestations In Patients With COVID-19:A Meta-analysis

Background:COVID-19 emerged at the end of 2019 and quickly spread around the world,taking a toll on health systems,societies and economies that continues to this day.Studies have shown that COVID-19 can cause a wide variety of neurological manifestations.In this study,meta-analysis was used to summarize various neurological manifestations of COVID-19 patients and statistically analyze the incidence of various neurological manifestations.Furthermore,the mechanism and prognosis of nervous system damage will be further explored to provide theoretical basis for clinical treatment plans for the prevention and control of emerging infectious diseases like COVID-19 in the future,and to reduce complications of nerve injury and fatality rate through early recognition and intervention.Method:From January 1,2020 to April 30,2021,English literature on COVID-19-related neurological manifestations in Pubmed,Embase,and The Cochrane Library was searched.The search terms used were COVID-19,neurological manifestations and related terms.All included studies were screened by two independent study members using the End Note X9 software.Any disputes were decided by consensus or by the intervention of a third study member.Finally,data were extracted and meta-analyzed using random effects model.Result:A total of 168 articles（N=292693）were included in the study,and the meta-analysis showed that the most common neurological manifestations of COVID-19 were myalgia（33%;95%CI 0.30–0.37;I~2=99.17%）,smell impairment（33%;95%CI 0.28–0.38;I~2=99.40%）,taste dysfunction（33%;95%CI 0.27–0.39;I~2=99.09%）,altered mental status（32%;95%CI 0.22–0.43;I~2=99.06%）,headache（29%;95%CI 0.25–0.33;I~2=99.42%）,encephalopathy（26%;95%CI 0.16–0.38;I~2=99.31%）,alteration of consciousness（13%;95%CI 0.08–0.19;I~2=98.10%）,stroke（12%;95%CI 0.08–0.16;I~2=98.95%）,dizziness（10%;95%CI 0.08–0.13;I~2=96.45%）,vision impairment（6%;95%CI 0.03–0.09;I~2=86.82%）,intracerebral haemorrhage（5%;95%CI 0.03–0.09;I~2=95.60%）,seizure（4%;95%CI 0.02-0.05;I~2=98.15%）,encepha-litis（2%;95%CI 0.01–0.03;I~2=90.36%）,Guillan-BarréSyndrome（GBS）（1%;95%CI 0.00–0.03;I~2=89.48%）.Conclusion:（1）Neurological damage was common and manifested in a variety of forms in COVID-19 patients,involving the central and peripheral nervous systems to varying degrees.（2）The most common neurological manifestations of COVID-19patients were myalgia,smell impairment,taste dysfunction and altered mental status;followed by headache,encephalopathy,alteration of consciousness,stroke,dizziness,vision impairment,intracerebral haemorrhage and seizure,while encephalitis and Guillan-BarréSyndrome were relatively rare.Among them,the most common central nervous system symptoms were altered mental status,headache,alteration of consciousness and dizziness;the most common central nervous system diseases were encephalopathy,stroke,intracerebral haemorrhage,seizure and encephalitis.The most common peripheral nervous system symptoms were myalgia,smell impairment,taste dysfunction and vision impairment.（3）In the severe and non-severe COVID-19 patients,the morbidity rate of headache was no large difference.The incidence of dizziness and seizures was higher in the severe COVID-19 patients,while the incidence of myalgia,smell impairment and taste dysfunction was lower.（4）The possible mechanisms of nerve function injury caused by SARS-Co V-2 infection include ACE₂receptor,trans-synaptic pathway through olfactory bulb,hematogenous diffusion,blood-brain barrier,hypoxia,inflammation and neuroimmune deficiency.（5）Patients recovering from COVID-19 can still have neurological sequelae and poor prognosis.（6）Early and highly sensitive neurobiomarkers and neurological examination methods can not only serve as diagnostic tools for COVID-19 patients in the acute infection stage,but also help predict the severity of patients’neurological impairment,providing better help for early intervention and prognosis.