Neurological associations of COVID-19
Open accessAbstract
BACKGROUND: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is of a scale not seen since the 1918 influenza pandemic. Although the predominant clinical presentation is with respiratory disease, neurological manifestations are being recognised increasingly. On the basis of knowledge of other coronaviruses, especially those that caused the severe acute respiratory syndrome and Middle East respiratory syndrome epidemics, cases of CNS and peripheral nervous system disease caused by SARS-CoV-2 might be expected to be rare. RECENT DEVELOPMENTS: A growing number of case reports and series describe a wide array of neurological manifestations in 901 patients, but many have insufficient detail, reflecting the challenge of studying such patients. Encephalopathy has been reported for 93 patients in total, including 16 (7%) of 214 hospitalised patients with COVID-19 in Wuhan, China, and 40 (69%) of 58 patients in intensive care with COVID-19 in France. Encephalitis has been described in eight patients to date, and Guillain-Barré syndrome in 19 patients. SARS-CoV-2 has been detected in the CSF of some patients. Anosmia and ageusia are common, and can occur in the absence of other clinical features. Unexpectedly, acute cerebrovascular disease is also emerging as an important complication, with cohort studies reporting stroke in 2-6% of patients hospitalised with COVID-19. So far, 96 patients with stroke have been described, who frequently had vascular events in the context of a pro-inflammatory hypercoagulable state with elevated C-reactive protein, D-dimer, and ferritin. WHERE NEXT?: Careful clinical, diagnostic, and epidemiological studies are needed to help define the manifestations and burden of neurological disease caused by SARS-CoV-2. Precise case definitions must be used to distinguish non-specific complications of severe disease (eg, hypoxic encephalopathy and critical care neuropathy) from those caused directly or indirectly by the virus, including infectious, para-infectious, and post-infectious encephalitis, hypercoagulable states leading to stroke, and acute neuropathies such as Guillain-Barré syndrome. Recognition of neurological disease associated with SARS-CoV-2 in patients whose respiratory infection is mild or asymptomatic might prove challenging, especially if the primary COVID-19 illness occurred weeks earlier. The proportion of infections leading to neurological disease will probably remain small. However, these patients might be left with severe neurological sequelae. With so many people infected, the overall number of neurological patients, and their associated health burden and social and economic costs might be large. Health-care planners and policy makers must prepare for this eventuality, while the many ongoing studies investigating neurological associations increase our knowledge base.
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Neurological and cardiovascular complications are common in COVID-19 patients.
“Neurological and cardiovascular complications are also common observations in COVID‐19 patients (Ellul et al, 2020; Zheng et al, 2020).”
From The struggle of a good friend getting old: cellular senescence in viral responses and therapy (2021) · cites this paper as Ellul et al, 2020
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An interactive web-based dashboard to track COVID-19 in real time
Dong, E., Du, H., & Gardner, L. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30120-1 · Cited by 10,048 · see citing works
COVID-19: consider cytokine storm syndromes and immunosuppression
Mehta, P., McAuley, D. F., Brown, M., Sanchez, E., Tattersall, R. S., & Manson, J. J. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30628-0 · Cited by 9,664 · see citing works
Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China
Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., et al. (2020) · JAMA Neurology · doi:10.1001/jamaneurol.2020.1127 · Cited by 7,166 · see citing works
Virological assessment of hospitalized patients with COVID-2019
Wölfel, R., Corman, V. M., Guggemos, W., Seilmaier, M., Zange, S., Müller, M. A., Niemeyer, D., Jones, T. C., Vollmar, P., Rothe, C., et al. (2020) · Nature · doi:10.1038/s41586-020-2196-x · Cited by 6,661 · see citing works
Endothelial cell infection and endotheliitis in COVID-19
Varga, Z., Flammer, A. J., Steiger, P., Haberecker, M., Andermatt, R., Zinkernagel, A. S., Mehra, M. R., Schuepbach, R. A., Ruschitzka, F., & Moch, H. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30937-5 · Cited by 6,358 · see citing works
Hamming, I., Timens, W., Bulthuis, M., Lely, A., Navis, G., & van Goor, H. (2004) · The Journal of Pathology · doi:10.1002/path.1570 · Cited by 5,676 · see citing works
Incidence of thrombotic complications in critically ill ICU patients with COVID-19
Klok, F. A., Kruip, M. J. H. A., van der Meer, N. J. M., Arbous, M. S., Gommers, D. A. M. P. J., Kant, K. M., Kaptein, F. H. J., van Paassen, J., Stals, M. A. M., Huisman, M. V., et al. (2020) · Thrombosis Research · doi:10.1016/j.thromres.2020.04.013 · Cited by 5,028 · see citing works
Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2
Yan, R., Zhang, Y., Li, Y., Xia, L., Guo, Y., & Zhou, Q. (2020) · Science · doi:10.1126/science.abb2762 · Cited by 4,950 · see citing works
A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome
Tg, K., Erdman, D. D., Cs, G., Zaki, Peret, T. C. T., Emery, S. L., Tong, S., Urbani, C., Comer, J. A., Lim, W., et al. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa030781 · Cited by 4,345 · see citing works
Temporal dynamics in viral shedding and transmissibility of COVID-19
He, X., Lau, E. H. Y., Wu, P., Deng, X., Wang, J., Hao, X., Lau, Y. C., Wong, J. Y., Guan, Y., Tan, X., et al. (2020) · Nature Medicine · doi:10.1038/s41591-020-0869-5 · Cited by 4,242 · see citing works
Neurologic features in severe SARS-CoV-2 infection
Helms, J., Kremer, S., Merdji, H., Clere-Jehl, R., Schenck, M., Kummerlen, C., Collange, O., Boulay, C., Fafi-Kremer, S., Ohana, M., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2008597 · Cited by 2,674 · see citing works
Lechien, J. R., Chiesa-Estomba, C. M., De Siati, D. R., Horoi, M., Le Bon, S. D., Rodriguez, A., Dequanter, D., Blecic, S., El Afia, F., Distinguin, L., et al. (2020) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-020-05965-1 · Cited by 2,668 · see citing works
Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19
Zhang, Y., Xiao, M., Zhang, S., Xia, P., Cao, W., Jiang, W., Chen, H., Ding, X., Zhao, H., Zhang, H., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2007575 · Cited by 2,179 · see citing works
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young
Oxley, T. J., Mocco, J., Majidi, S., Kellner, C. P., Shoirah, H., Singh, I. P., Leacy, R. A. D., Shigematsu, T., Ladner, T. R., Yaeger, K., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2009787 · Cited by 2,114 · see citing works
Lodigiani, C., Iapichino, G., Carenzo, L., Cecconi, M., Ferrazzi, P., Sebastian, T., Kucher, N., Studt, J.-D., Sacco, C., Bertuzzi, A., et al. (2020) · Thrombosis Research · doi:10.1016/j.thromres.2020.04.024 · Cited by 2,054 · see citing works
A first case of meningitis/encephalitis associated with SARS-Coronavirus-2
Moriguchi, T., Harii, N., Goto, J., Harada, D., Sugawara, H., Takamino, J., Ueno, M., Sakata, H., Kondo, K., Myose, N., et al. (2020) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2020.03.062 · Cited by 2,024 · see citing works
ISTH interim guidance on recognition and management of coagulopathy in COVID‐19
Thachil, J. V., Tang, N., Gando, S., Falanga, A., Cattaneo, M., Levi, M. M., Clark, C., & Iba, T. (2020) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.14810 · Cited by 1,957 · see citing works
Viral dynamics in mild and severe cases of COVID-19
Liu, Y., Yan, L.-M., Wan, L., Xiang, T.-X., Le, A., Liu, J.-M., Peiris, M., Poon, L. L. M., & Zhang, W. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30232-2 · Cited by 1,727 · see citing works
1918 Influenza: the Mother of All Pandemics
Taubenberger, J. K., & Morens, D. M. (2006) · Emerging Infectious Diseases · doi:10.3201/eid1201.050979 · Cited by 1,686 · see citing works
Willison, H. J., Jacobs, B. C., & van Doorn, P. A. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00339-1 · Cited by 1,634 · see citing works
1918 Influenza: the Mother of All Pandemics
Taubenberger, J. K., & Morens, D. M. (2006) · Emerging Infectious Diseases · doi:10.3201/eid1209.05-0979 · Cited by 1,590 · see citing works
COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features
Poyiadji, N., Shahin, G., Noujaim, D., Stone, M., Patel, S., & Griffith, B. (2020) · Radiology · doi:10.1148/radiol.2020201187 · Cited by 1,505 · see citing works
Netland, J., Meyerholz, D. K., Moore, S., Cassell, M., & Perlman, S. (2008) · Journal of Virology · doi:10.1128/jvi.00737-08 · Cited by 1,293 · see citing works
Guillain–Barré Syndrome Associated with SARS-CoV-2
Toscano, G., Palmerini, F., Ravaglia, S., Ruiz, L., Invernizzi, P., Cuzzoni, M. G., Franciotta, D. M., Baldanti, F., Daturi, R., Postorino, P., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2009191 · Cited by 1,266 · see citing works
Venkatesan, A., Tunkel, A. R., Bloch, K. C., Lauring, A. S., Sejvar, J. J., Bitnun, A., Stahl, J. ‐., Mailles, A., DREBOT, M. A., Rupprecht, C. E., et al. (2013) · Clinical Infectious Diseases · doi:10.1093/cid/cit458 · Cited by 1,223 · see citing works
Self-citationKrupp, L. B., Tardieu, M., Amato, M. P., Banwell, B., Chitnis, T., Dale, R. C., Ghezzi, A., Hintzen, R., Kornberg, A., Pohl, D., et al. (2013) · Multiple Sclerosis Journal · doi:10.1177/1352458513484547 · Cited by 1,130 · see citing works
Li, Y., 王梦嵽, Zhou, Y., Chang, J., Xian, Y., Mao, L., Hong, C., Chen, S., Wang, Y., Wang, H., et al. (2020) · Stroke and Vascular Neurology · doi:10.1136/svn-2020-000431 · Cited by 1,062 · see citing works
Desforges, M., Le Coupanec, A., Dubeau, P., Bourgouin, A., Lajoie, L., Dubé, M., & Talbot, P. J. (2019) · Viruses · doi:10.3390/v12010014 · Cited by 1,048 · see citing works
Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?
Zhao, H., Shen, D., Zhou, H., Liu, J., & Chen, S. (2020) · The Lancet Neurology · doi:10.1016/s1474-4422(20)30109-5 · Cited by 987 · see citing works
Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
Paniz‐Mondolfi, A., Bryce, C., Grimes, Z., Gordon, R. E., Reidy, J., Lednicky, J., Sordillo, E. M., & Fowkes, M. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25915 · Cited by 975 · see citing works
Miller Fisher syndrome and polyneuritis cranialis in COVID-19
Gutiérrez-Ortiz, C., Méndez-Guerrero, A., Rodrigo-Rey, S., Murillo, E. S. P., Bermejo‐Guerrero, L., Mañas, R. G., de Aragón, F., & Benito‐León, J. (2020) · Neurology · doi:10.1212/wnl.0000000000009619 · Cited by 801 · see citing works
Smell dysfunction: a biomarker for COVID‐19
Moein, S. T., Hashemian, S. M. R., Mansourafshar, B., Khorram‐Tousi, A., Tabarsi, P., & Doty, R. L. (2020) · International Forum of Allergy & Rhinology · doi:10.1002/alr.22587 · Cited by 793 · see citing works
Vanhorebeek, I., Latronico, N., & den Berghe, G. V. (2020) · Intensive Care Medicine · doi:10.1007/s00134-020-05944-4 · Cited by 768 · see citing works
Chu, H., Chan, J. F., Yuen, T. T., Shuai, H., Yuan, S., Wang, Y., Hu, B., Yip, C. C., Tsang, J. O., Huang, X., et al. (2020) · The Lancet Microbe · doi:10.1016/s2666-5247(20)30004-5 · Cited by 754 · see citing works
Characteristics of ischaemic stroke associated with COVID-19
Beyrouti, R., Adams, M. E., Benjamin, L., Cohen, H., Farmer, S. F., Goh, Y. Y., Humphries, F., Jäger, H. R., Losseff, N. A., Perry, R. J., et al. (2020) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2020-323586 · Cited by 711 · see citing works
Self-citationNeurological manifestations of dengue infection
Solomon, T., Dung, N. M., Vaughn, D. W., et al. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02036-5 · Cited by 634 · see citing works
Self-citationGilden, D., Cohrs, R. J., Mahalingam, R., & Nagel, M. A. (2009) · The Lancet Neurology · doi:10.1016/s1474-4422(09)70134-6 · Cited by 613 · see citing works
Avula, A., Nalleballe, K., Narula, N., Sapozhnikov, S., Dandu, V., Toom, S., Glaser, A., & Elsayegh, D. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.04.077 · Cited by 558 · see citing works
Antibody Detection and Dynamic Characteristics in Patients With Coronavirus Disease 2019
Xiang, F., Wang, X., He, X., Peng, Z., Yang, B., Zhang, J., Zhou, Q., Ye, H., Ma, Y., Li, H., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa461 · Cited by 535 · see citing works
Neurological complications during treatment of middle east respiratory syndrome
Kim, J.-E., Heo, J.-H., Kim, H.-O., Song, S.-H., Park, S.-S., Park, T.-H., Ahn, J.-Y., Kim, M.-K., & Choi, J.-P. (2017) · Journal of Clinical Neurology · doi:10.3988/jcn.2017.13.3.227 · Cited by 497 · see citing works
Xu, J., Zhong, S., Liu, J., Li, L., Li, Y., Wu, X., Li, Z., Deng, P., Zhang, J., Zhong, N. S., et al. (2005) · Clinical Infectious Diseases · doi:10.1086/444461 · Cited by 492 · see citing works
Saad, M., Omrani, A. S., Baig, K., Bahloul, A., Elzein, F., Matin, M. A., Selim, M. A. A., Mutairi, M. A., Nakhli, D. A., Aidaroos, A. Y. A., et al. (2014) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2014.09.003 · Cited by 486 · see citing works
Solomon, T., Michael, B. D., Smith, P. E., Sanderson, F., Davies, N. W. S., Hart, I. J., Holland, M., Easton, A., Buckley, C. J., Kneen, R., et al. (2011) · Journal of Infection · doi:10.1016/j.jinf.2011.11.014 · Cited by 466 · see citing works
Self-citationAcute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome
Pohl, D., Alper, G., Van Haren, K., Kornberg, A. J., Lucchinetti, C. F., Tenembaum, S., & Belman, A. L. (2016) · Neurology · doi:10.1212/wnl.0000000000002825 · Cited by 462 · see citing works
Acute ischaemic stroke and infection: recent and emerging concepts
Emsley, H. C. A., & Hopkins, S. J. (2008) · The Lancet Neurology · doi:10.1016/s1474-4422(08)70061-9 · Cited by 419 · see citing works
Possible Central Nervous System Infection by SARS Coronavirus
Lau, K., Yu, W.-C., Chu, C., Lau, S.-T., Sheng, B., & Yuen, K. (2004) · Emerging infectious diseases · doi:10.3201/eid1002.030638 · Cited by 395 · see citing works
Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV)
Arabi, Y. M., Alharthi, A. F., Hussein, J., Bouchama, A., Johani, S. A., Hajeer, A. H., Saeed, B. T., Wahbi, A. M. A., Saedy, A., Aldabbagh, T., et al. (2015) · Infection · doi:10.1007/s15010-015-0720-y · Cited by 389 · see citing works
SARS-CoV-2 can induce brain and spine demyelinating lesions
Zanin, L., Saraceno, G., Panciani, P. P., Renisi, G., Signorini, L., Migliorati, K., & Fontanella, M. M. (2020) · Acta Neurochirurgica · doi:10.1007/s00701-020-04374-x · Cited by 375 · see citing works
Beltrán‐Corbellini, Á., Chico‐García, J. L., Martínez‐Poles, J., Rodríguez‐Jorge, F., Natera‐Villalba, E., Gómez-Corral, J., López, A. G., Monreal, E., Parra‐Díaz, P., Cortes-Cuevas, J. L., et al. (2020) · European Journal of Neurology · doi:10.1111/ene.14273 · Cited by 362 · see citing works
Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies
Slooter, A. J. C., Otte, W. M., Devlin, J. W., Arora, R. C., Bleck, T. P., Claassen, J., Duprey, M. S., Ely, E. W., Kaplan, P. W., Latronico, N., et al. (2020) · Intensive Care Medicine · doi:10.1007/s00134-019-05907-4 · Cited by 360 · see citing works
The neurological complications of sepsis
Bolton, C. F., Bryan, G. Y., & Zochodne, D. W. (1993) · Annals of Neurology · doi:10.1002/ana.410330115 · Cited by 347 · see citing works
Rhabdomyolysis as Potential Late Complication Associated with COVID-19
Jin, M., & Tong, Q. (2020) · Emerging infectious diseases · doi:10.3201/eid2607.200445 · Cited by 341 · see citing works
Guillain-Barré syndrome related to COVID-19 infection
Alberti, P., Beretta, S., Piatti, M., Karantzoulis, A., Piatti, M. L., Santoro, P., Viganò, M., Giovannelli, G., Pirro, F., Montisano, D. A., et al. (2020) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000000741 · Cited by 335 · see citing works
Yeh, E. A., Collins, A. R., Cohen, M. E., Duffner, P. K., & Faden, H. S. (2004) · PEDIATRICS · doi:10.1542/peds.113.1.e73 · Cited by 329 · see citing works
COVID-19 presenting with ophthalmoparesis from cranial nerve palsy
Dinkin, M., Gao, V., Kahan, J., Bobker, S. M., Simonetto, M., Wechsler, P. M., Harpe, J. M., Greer, C. E., Mints, G., Salama, G. R., et al. (2020) · Neurology · doi:10.1212/wnl.0000000000009700 · Cited by 327 · see citing works
Steroid‐Responsive Encephalitis in Coronavirus Disease 2019
Pilotto, A., Odolini, S., Masciocchi, S., Comelli, A., Volonghi, I., Gazzina, S., Nocivelli, S., Pezzini, A., Focà, E., Caruso, A., et al. (2020) · Annals of Neurology · doi:10.1002/ana.25783 · Cited by 314 · see citing works
COVID-19 and intracerebral haemorrhage: causative or coincidental?
Razavi, A. S., Karimi, N., & Rouhani, N. (2020) · New Microbes and New Infections · doi:10.1016/j.nmni.2020.100669 · Cited by 303 · see citing works
Diagnostic value and dynamic variance of serum antibody in coronavirus disease 2019
Jin, Y., Wang, M., Zuo, Z., Fan, C., Ye, F., Cai, Z., Wang, Y., Cui, H., Pan, K.-N., & Xu, A. (2020) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2020.03.065 · Cited by 295 · see citing works
Sars-Cov-2: Underestimated damage to nervous system
Zhou, L., Zhang, M., Wang, J., & Gao, J. (2020) · Travel Medicine and Infectious Disease · doi:10.1016/j.tmaid.2020.101642 · Cited by 280 · see citing works
Human Coronavirus OC43 Associated with Fatal Encephalitis
Morfopoulou, S., Brown, J. R., Davies, E. G., Anderson, G. W., Virasami, A. K., Qasim, W., Chong, W. K., Hubank, M. J. F., Plagnol, V., Desforges, M., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmc1509458 · Cited by 276 · see citing works
Garazzino, S., Montagnani, C., Donà, D., Meini, A., Felici, E., Vergine, G., Bernardi, S., Giacchero, R., Vecchio, A. L., Marchisio, P., et al. (2020) · Eurosurveillance · doi:10.2807/1560-7917.es.2020.25.18.2000600 · Cited by 275 · see citing works
Stroke in patients with SARS-CoV-2 infection: case series
Morassi, M., Bagatto, D., Cobelli, M., D’Agostini, S., Gigli, G. L., Bnà, C., & Vogrig, A. (2020) · Journal of Neurology · doi:10.1007/s00415-020-09885-2 · Cited by 269 · see citing works
Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke
Saiegh, F. A., Ghosh, R., Leibold, A. T., Avery, M. B., Schmidt, R. F., Theofanis, T. N., Mouchtouris, N., Philipp, L. R., Peiper, S. C., Wang, Z., et al. (2020) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2020-323522 · Cited by 255 · see citing works
Guillain-Barré Syndrome associated with SARS-CoV-2 infection
Virani, A., Rabold, E., Hanson, T., HAAG, A. L., Elrufay, R., Cheema, T. J., Balaan, M. R., & Bhanot, N. (2020) · IDCases · doi:10.1016/j.idcr.2020.e00771 · Cited by 252 · see citing works
Neuromuscular Disorders in Severe Acute Respiratory Syndrome
Tsai, L., Hsieh, S., Chao, C., Chen, Y., Lin, Y.-H., Chang, S., & Chang, Y. (2004) · Archives of Neurology · doi:10.1001/archneur.61.11.1669 · Cited by 247 · see citing works
Hung, E. C. W., Chim, S. S. C., Chan, P. K. S., Tong, Y. K., Ng, E. K. O., Chiu, R. W. K., Leung, C., Sung, J. J. �., Tam, J. S., & Lo, Y. M. D. (2003) · Clinical Chemistry · doi:10.1373/clinchem.2003.025437 · Cited by 247 · see citing works
Duong, L. N., Xu, P., & Liu, A. K. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.04.024 · Cited by 240 · see citing works
Benussi, A., Pilotto, A., Premi, E., Libri, I., Giunta, M., Agosti, C., Alberici, A., Baldelli, E., Benini, M., Bonacina, S., et al. (2020) · Neurology · doi:10.1212/wnl.0000000000009848 · Cited by 227 · see citing works
Influenza virus and CNS manifestations
Studahl, M. (2003) · Journal of Clinical Virology · doi:10.1016/s1386-6532(03)00119-7 · Cited by 214 · see citing works
Utility of hyposmia and hypogeusia for the diagnosis of COVID-19
Bénézit, F., Turnier, P. L., Declerck, C., Paillé, C., Revest, M., Dubée, V., Tattevin, P., Arvieux, C., Baldeyrou, M., Chapplain, J.-M., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30297-8 · Cited by 213 · see citing works
Li, Y., Li, H., Fan, R., Wen, B., Zhang, J., Cao, X., Wang, C., Song, Z., Li, S., Li, X., et al. (2016) · Intervirology · doi:10.1159/000453066 · Cited by 203 · see citing works
Two patients with acute meningoencephalitis concomitant with SARS‐CoV‐2 infection
Bernard‐Valnet, R., Pizzarotti, B., Anichini, A., Demars, Y., Russo, E., Schmidhauser, M., Cerutti-Sola, J., Rossetti, A. O., & Pasquier, R. D. (2020) · European Journal of Neurology · doi:10.1111/ene.14298 · Cited by 200 · see citing works
Focal status epilepticus as unique clinical feature of COVID-19: A case report
Vollono, C., Rollo, E., Romozzi, M., et al. (2020) · Seizure · doi:10.1016/j.seizure.2020.04.009 · Cited by 199 · see citing works
Guillain-Barré syndrome following COVID-19: new infection, old complication?
Padroni, M., Mastrangelo, V., Asioli, G. M., Pavolucci, L., Abu‐Rumeileh, S., Piscaglia, M. G., Querzani, P., Callegarini, C., & Foschi, M. (2020) · Journal of Neurology · doi:10.1007/s00415-020-09849-6 · Cited by 199 · see citing works
Hornuß, D., Lange, B., Schröter, N., Rieg, S., Kern, W. V., & Wagner, D. (2020) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2020.05.017 · Cited by 196 · see citing works
COVID-19 may induce Guillain–Barré syndrome
Camdessanché, J., Morel, J., Pozzetto, B., et al. (2020) · Revue Neurologique · doi:10.1016/j.neurol.2020.04.003 · Cited by 190 · see citing works
Goenka, A., Michael, B. D., Ledger, E., Hart, I. J., Absoud, M., Chow, G., Lilleker, J. B., Lunn, M. P., McKee, D., Peake, D., et al. (2013) · Clinical Infectious Diseases · doi:10.1093/cid/cit922 · Cited by 180 · see citing works
Self-citationAlgahtani, H. A., Subahi, A. M., & Shirah, B. H. (2016) · Case Reports in Neurological Medicine · doi:10.1155/2016/3502683 · Cited by 177 · see citing works
Causality in acute encephalitis: defining aetiologies
Granerød, J., Cunningham, R., Zuckerman, M. A., Mutton, K. J., Davies, N. W. S., Walsh, A. L., Ward, K. N., Hilton, D. A., Ambrose, H. E., Clewley, J. P., et al. (2010) · Epidemiology and Infection · doi:10.1017/s0950268810000725 · Cited by 167 · see citing works
Self-citationRhabdomyolysis as a Presentation of 2019 Novel Coronavirus Disease
Suwanwongse, K., & Shabarek, N. (2020) · Cureus · doi:10.7759/cureus.7561 · Cited by 164 · see citing works
Varatharaj, A., Thomas, N., Ellul, M., Davies, N. W., Pollak, T., Tenorio, E. L., Sultan, M., Easton, A., Breen, G., Zandi, M., et al. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3601761 · Cited by 160 · see citing works
Self-citationCOVID-19 Presenting with Seizures
Sohal, S., & Mansur, M. (2020) · IDCases · doi:10.1016/j.idcr.2020.e00782 · Cited by 148 · see citing works
Neurologic manifestations in an infant with COVID-19
Dugue, R., Cay-Martínez, K. C., Thakur, K. T., Garcia, J. A., Chauhan, L. V., Williams, S. H., Briese, T., Jain, K., Foca, M. D., McBrian, D. K., et al. (2020) · Neurology · doi:10.1212/wnl.0000000000009653 · Cited by 144 · see citing works
Dynamics of anti-SARS-Cov-2 IgM and IgG antibodies among COVID-19 patients
Lee, Y.-L., Liao, C.-H., Liu, P., et al. (2020) · Journal of Infection · doi:10.1016/j.jinf.2020.04.019 · Cited by 139 · see citing works
Covid-19 and Guillain-Barré syndrome: More than a coincidence!
Otmani, H. E., Moutawakil, B. E., Rafai, M. A., et al. (2020) · Revue Neurologique · doi:10.1016/j.neurol.2020.04.007 · Cited by 123 · see citing works
Infectious causes of acute flaccid paralysis
Solomon, T., & Willison, H. J. (2003) · Current Opinion in Infectious Diseases · doi:10.1097/00001432-200310000-00002 · Cited by 121 · see citing works
Self-citationWong, P. F., Craik, S., Newman, P., et al. (2020) · Clinical Medicine · doi:10.7861/clinmed.2020-0182 · Cited by 116 · see citing works
A Population-Based Study of Neurologic Manifestations of Severe Influenza A(H1N1)pdm09 in California
Glaser, C. A., Winter, K., DuBray, K. A., Harriman, K. H., Uyeki, T. M., Sejvar, J. J., Gilliam, S., & Louie, J. K. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis454 · Cited by 114 · see citing works
Self-citationMehta, R., Soares, C., Medialdea‐Carrera, R., Ellul, M. A., da Silva, M. T. T., Rosala‐Hallas, A., Jardim, M. R., Burnside, G., Pamplona, L. D. A. E. L., Bhojak, M., et al. (2018) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0006212 · Cited by 112 · see citing works
Self-citationGuillain-Barré syndrome as a complication of SARS-CoV-2 infection
Coen, M., Jeanson, G., Almeida, L., Hübers, A., Stierlin, F., Najjar, I., Ongaro, M., Moulin, K., Makrygianni, M., Leemann, B., et al. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.04.074 · Cited by 103 · see citing works
Emergency room neurology in times of COVID‐19: malignant ischaemic stroke and SARS‐CoV‐2 infection
González, T. G.-P., Rodríguez, A. L., Estébanez, A. M., Agirre-Beitia, G., Rodríguez-Antigüedad, A., & Ruíz-López, M. (2020) · European Journal of Neurology · doi:10.1111/ene.14286 · Cited by 100 · see citing works
How Viruses Contribute to the Pathogenesis of Hemophagocytic Lymphohistiocytosis
Brisse, E., Wouters, C. H., Andreï, G., & Matthys, P. (2017) · Frontiers in Immunology · doi:10.3389/fimmu.2017.01102 · Cited by 100 · see citing works
Viral-associated thrombotic microangiopathies
da Silva, R. L. (2011) · Hematology/Oncology and Stem Cell Therapy · doi:10.5144/1658-3876.2011.51 · Cited by 93 · see citing works
Neurologic complications of influenza A(H1N1)pdm09
Khandaker, G., Zurynski, Y. A., Buttery, J. P., Marshall, H. S., Richmond, P., Dale, R. C., Royle, J., Gold, M., Snelling, T., Whitehead, B., et al. (2012) · Neurology · doi:10.1212/wnl.0b013e31826d5ea7 · Cited by 91 · see citing works
COVID 19 infection presenting as motor peripheral neuropathy
Abdelnour, L. H., Abdalla, M. E., & Babiker, S. (2020) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2020.04.024 · Cited by 72 · see citing works
COVID-19: Fever syndrome and neurological symptoms in a neonate
Aguilar, R. C., Osorio-Cámara, J. M., Sanjurjo-Jimenez, I., González, C. G., López-Carnero, J., & Pérez‐Moneo, B. (2020) · Anales de Pediatría (English Edition) · doi:10.1016/j.anpede.2020.04.001 · Cited by 69 · see citing works
Pulmonary, Cerebral, and Renal Thromboembolic Disease in a Patient with COVID-19
Lushina, N., Kuo, J. S., & Shaikh, H. A. (2020) · Radiology · doi:10.1148/radiol.2020201623 · Cited by 64 · see citing works
Small proportions: what to report for confidence intervals?
Tobi, H., van den Berg, P. B., & den Berg, L. T. D. J.-V. (2005) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1081 · Cited by 58 · see citing works
Gu, Y., Shimada, T., Yasui, Y., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0054786 · Cited by 53 · see citing works
Síndrome de Guillain-Barré asociado a infección por SARS-CoV-2
Galán, A. V., Saucedo, P. D. S., Postigo, F. P., & Botia-Paniagua, E. (2020) · Neurología · doi:10.1016/j.nrl.2020.04.007 · Cited by 47 · see citing works
Síndrome de Guillain-Barré fatal tras infección por el virus SARS-CoV-2
Marta-Enguita, J., Rubio-Baines, I., & Gastón-Zubimendi, I. (2020) · Neurología · doi:10.1016/j.nrl.2020.04.004 · Cited by 45 · see citing works
Moshayedi, P., Ryan, T. E., Mejia, L. L. P., Nour, M., & Liebeskind, D. S. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00353 · Cited by 44 · see citing works
Fatal Guillain-Barre syndrome after infection with SARS-CoV-2
Marta-Enguita, J., Rubio-Baines, I., & Gastón-Zubimendi, I. (2020) · Neurología (English Edition) · doi:10.1016/j.nrleng.2020.04.004 · Cited by 42 · see citing works
Respiratory failure alone does not suggest central nervous system invasion by SARS‐CoV‐2
Turtle, L. C. W. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25828 · Cited by 41 · see citing works
Foley, P. B. (2008) · Journal of Neural Transmission · doi:10.1007/s00702-008-0161-1 · Cited by 26 · see citing works
Neurologic Complications and Outcomes of Pandemic (H1N1) 2009 in Korean Children
Kwon, S., Kim, S., Cho, M. H., & Seo, H.-E. (2012) · Journal of Korean Medical Science · doi:10.3346/jkms.2012.27.4.402 · Cited by 19 · see citing works
Paciente con clínica neurológica como única manifestación de infección por SARS-CoV-2
Pellitero, S. E., & Ferrer-Bergua, L. G. (2020) · Neurología · doi:10.1016/j.nrl.2020.04.010 · Cited by 14 · see citing works
Report of a patient with neurological symptoms as the sole manifestation of SARS-CoV-2 infection
Pellitero, S. E., & Ferrer-Bergua, L. G. (2020) · Neurología (English Edition) · doi:10.1016/j.nrleng.2020.04.009 · Cited by 14 · see citing works
Flagged first, then by citations
Research works printed but not linked: 6
- [41]Zhang T Rodricks MB Hirsh E COVID-19-associated acute disseminated encephalomyelitis: a case report medRxiv 2020 https://doi.org.2020.04.16.20068148 (preprint).
- [42]Zhao K Huang J Dai D Feng Y Liu L Nie S Acute myelitis after SARS-CoV-2 infection: a case report medRxiv 2020 https://doi.org.2020.03.16.20035105 (preprint).
- [78]Zhai P Ding Y Li Y The impact of COVID-19 on ischemic stroke: a case report Research Square 2020 published online March 31. 10.21203/rs.3.rs-20393/v1 (preprint). PMC7323364 32600350 · DOI
- [85]Jin M Tong Q Rhabdomyolysis as potential late complication associated with COVID-19 Emerg Infect Dis 2020 https://doi.org.10.3201/eid2607.200445 published online March 20. PMC7323559 32197060 · DOI
- [87]Luers JC Klussmann JP Guntinas-Lichius O The Covid-19 pandemic and otolaryngology: what it comes down to? Laryngorhinootologie 99 2020 287 291 32215896
- [98]Solomon T Encephalitis, and infectious encephalopathies Donaghy M Brain's diseases of the nervous system 12th edn. 2009 Oxford University Press Oxford
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Nalbandian, A., Sehgal, K., Gupta, A., Madhavan, M. V., McGroder, C., Stevens, J. S., Cook, J. R., Nordvig, A. S., Shalev, D., Sehrawat, T. S., et al. (2021) · Nature Medicine · doi:10.1038/s41591-021-01283-z · Cited by 4,862 · see citing works
Taquet, M., Geddes, J. R., Husain, M., Luciano, S., & Harrison, P. J. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00084-5 · Cited by 2,189 · see citing works
Varatharaj, A., Thomas, N., Ellul, M. A., Davies, N. W. S., Pollak, T. A., Tenorio, E. L., Sultan, M., Easton, A., Breen, G., Zandi, M., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30287-x · Cited by 1,246 · see citing works
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Aiyegbusi, O. L., Hughes, S. E., Turner, G., Rivera, S. C., McMullan, C., Chandan, J. S., Haroon, S., Price, G., Davies, E. H., Nirantharakumar, K., et al. (2021) · Journal of the Royal Society of Medicine · doi:10.1177/01410768211032850 · Cited by 969 · see citing works
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Graham, E. L., Clark, J. R., Orban, Z. S., Lim, P. H., Szymanski, A. L., Taylor, C., DiBiase, R. M., Jia, D. T., Balabanov, R., Ho, S. U., et al. (2021) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.51350 · Cited by 693 · see citing works
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Yang, A. C., Kern, F., Losada, P. M., Agam, M. R., Maat, C. A., Schmartz, G. P., Fehlmann, T., Stein, J. A., Schaum, N., Lee, D. P., et al. (2021) · Nature · doi:10.1038/s41586-021-03710-0 · Cited by 620 · see citing works
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Dani, N., Herbst, R. H., McCabe, C., Green, G. S., Kaiser, K., Head, J. P., Cui, J., Shipley, F. B., Jang, A., Dionne, D., et al. (2021) · Cell · doi:10.1016/j.cell.2021.04.003 · Cited by 388 · see citing works
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“Meanwhile, autoimmunity may be another underlying mechanism for both the neurological (such as encephalitis and encephalopathy; Costello and Dalakas, 2020; Ellul et al., 2020) and psychiatric (such as psychosis and delirium; Hosseini et al.”
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Mansour, H. M. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102195 · Cited by 3 · see citing works
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“SARS-CoV-2 infections differ pathophysiologically from other RTIs, often involving intense systemic inflammation, endothelial dysfunction, and neurological sequelae [20,21].”
- Authors
- Ellul, M. A., Benjamin, L., Singh, B., Lant, S., Michael, B. D., Easton, A., Kneen, R., Defres, S., Sejvar, J., & Solomon, T.
- Affiliations
- National Health Service (GB)
- UCL Queen Square Institute of Neurology (GB)
- University of Liverpool (GB)
- Alder Hey Children's NHS Foundation Trust (GB)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Solomon, Tom
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 19
- Issue
- 9
- Pages
- 767-783
- ISSN
- 1474-4422 (ISSN-L)
- PMC
- PMC7332267
- OpenAlex
- W3024790435
- Cited by
- 2,156
- References
- 108
- Citations by year
- 2026: 55 · 2025: 120 · 2024: 167 · 2023: 271 · 2022: 477 · 2021: 813 · 2020: 250 · 2012: 1
- FWCI
- 51.01
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Neurology (publishedVersion, cc-by-nc-nd)
- SSRN Electronic Journal (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Wellcome Trust
- University of Oxford (NIHR200907)
- Academy of Medical Sciences
- Horizon 2020 (734584)
- British Association of Dermatologists
- National Institute for Health Research (17/63/110)
- Medical Research Council
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- COVID-19 pandemic, SARS-CoV-2, neurological symptoms, encephalopathy, encephalitis, Guillain-Barré syndrome, stroke, hypercoagulability, anosmia, ageusia, cerebrospinal fluid, post-infectious encephalitis, neurological sequelae, case definition, hyperinflammation
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Animals, Humans, Nervous System Diseases, Pneumonia, Viral, Coronavirus Infections, Severe Acute Respiratory Syndrome, Pandemics
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