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E1567. Neurological Complications in COVID-19: A Systematic Review of Literature
Authors
  1. Dhairya Lakhani; West Virginia University
  2. Samiksha Srivastava; University of Texas
  3. Saurabh Kataria; West Virginia University
  4. Shitiz Sriwastava; West Virginia University
Objective:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic affects more than 23 million population globally. As the spread continues, it is important that radiologists are aware of the emerging data and complications associated with SARS-CoV-2 [1-3]. There have been reports of neurological manifestations, however, in fewer numbers. The proposed mechanism includes: via the systemic circulation, or direct invasion through cribriform plate [4-7]. Extensive endothelial dysfunction from cytokine storm predisposes to thrombosis or hemorrhage and resultant stroke [5,8]. In our systematic review, therefore, we intend to summarize the clinical and imaging presentation of neurological manifestations associated with COVID-19 disease.

Materials and Methods:
Using the keywords “COVID-19 and CNS”, “SARS-CoV-2," and “CNS COVID-19 and neurological manifestation”, “SARS2 and neurological manifestation”, “COVID-19 and Brain”, we searched PubMed, Google Scholar, Scopus and Cochrane library. Of the resulting articles, we included original research, case series and case reports. Neurological manifestations obtained from these studies that were considered significant and included for analysis were, ischemic stroke, cerebral hemorrhage, cerebral venous thrombosis, encephalitis, GBS and its variants, seizures, ADEM and transverse myelitis. We used the preferred reporting items for systematic reviews and meta-analyses (PRISMA) for the display of inclusions and exclusions.

Results:
Twenty-six articles met the inclusion criteria. The significant neurological diagnoses reported were stroke, Guillain Barre Syndrome (GBS) and its variants, encephalitis, seizures, acute hemorrhagic necrotizing encephalopathy, acute disseminated encephalomyelitis (ADEM) and transverse myelitis. Although stroke, predominantly ischemic, was observed in approximately ?6% of COVID-19 patients from Wuhan, China, mortality in this cohort was 38%. Of the 24 pooled patients with reports of etiology, 17 had large vessel occlusions. GBS occurred in 5/1200 (0.4%) of the COVID-19 cohort from Italy. One of the six reported encephalitis cases, the ADEM case and the report of transverse myelitis do not have data for conclusive diagnosis. This is work-in-progress, which includes literature from December 2019 to May 2020, and we intend to continue acquiring more data as the literature on COVID-19 continues to grow.

Conclusion:
The most frequent neurological complication associated with COVID-19 is stroke, mainly ischemic, with a frequency of ?6%,with 38% mortality. Less common neurological associations of COVID-19, such as GBS/variants, encephalitis, seizures, and acute hemorrhagic necrotizing encephalopathy.