J Neurol . Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions

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J Neurol


. 2021 Oct 21;1-10.
doi: 10.1007/s00415-021-10848-4. Online ahead of print.
Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions


Ettore Beghi ¹ , Giorgia Giussani ² , Erica Westenberg ³ , Ricardo Allegri ⁴ , David Garcia-Azorin ⁵ , Alla Guekht ⁶ , Jennifer Frontera ⁷ , Miia Kivipelto ^{8 9} , Francesca Mangialasche ⁸ , Elizabeta B Mukaetova-Ladinska ¹⁰ , Kameshwar Prasad ¹¹ , Neerja Chowdhary ¹² , Andrea Sylvia Winkler ^{3 13}



Affiliations

• PMID: 34674005
• PMCID: PMC8528941
• DOI: 10.1007/s00415-021-10848-4

Free PMC article

Abstract

Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified.

Keywords: COVID-19; Neurological diseases; Post-COVID; SARS-CoV-2.