Neurological manifestations of COVID-19

Abstract

As of May 19, 2020, the COVID-19 pandemic, caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in more than 4•8 million confirmed cases worldwide and more than 300 000 deaths. It is the largest and most severe pandemic since the 1918 influenza pandemic. Although the most common and important presentation is with respiratory disease, reports of neurological features are increasing. These features appear to be a combination of non-specific complications of systemic disease, the effects of direct viral infection, or inflammation of the nervous system and vasculature, which can be para-infectious or post-infectious. In this Rapid Review, we consider which neurological manifestations might be expected for COVID-19, given what is known about related coronaviruses and respiratory viruses more broadly. We summarize the evidence to date for COVID-19, examine putative disease mechanisms, and finally suggest a framework for investigating patients with suspected COVID-19-associated neurological disease to support clinico-epidemiological, disease mechanism, and treatment studies.