key: cord-0770628-6ey36qsl authors: Meppiel, Elodie; Broucker, Thomas De title: Manifestations neurologiques associées au COVID-19 date: 2021-03-19 journal: nan DOI: 10.1016/j.praneu.2021.03.002 sha: 2193c8e2b4e27d38b8b85f72ce54ec2f8ec33135 doc_id: 770628 cord_uid: 6ey36qsl Introduction: The COVID-19 pandemic highlighted the existence of neurological manifestations associated with SARS-CoV-2 infection. The aim of this review was to summarize the prevalence and the range of neurological manifestations associated with COVID-19, and to expose the main hypotheses about the pathogenic pathways based on available neuropathological studies. Methods: Articles have been identified by searches of PubMed and Google scholar up to November 15, 2020, using a combination of COVID-19 and neurology search terms and adding relevant references in the articles. Results: Nonspecific neurological symptoms such as headache, dizziness, pain and myalgia, have been reported in 2 to 30% of COVID-19 hospitalized patients. More severe neurological diseases affected 8 to 13% of COVID-19 hospitalized patients including various central or peripheral manifestations. Among central nervous system involvement, encephalopathy and cerebrovascular disease – especially ischemic stroke - were the most frequent, followed by encephalitis, myelitis, meningitis, and posterior reversible encephalopathy syndrome. Guillain-Barré syndrome and variants were the most common form of peripheral nervous system involvement, followed by critical illness neuromyopathy, plexopathy, polyneuropathy, oculomotor neuropathy, and Tapia syndrome. Encephalopathy, ischemic stroke and encephalitis occurred 6 to 12 days in median after the first signs of COVID-19, while Guillain-Barré syndrome occured later, at 15 to 23 days in median. Taste and smell disorders affected 34 to 86% of patients and occurred 3.5 days in median after the onset of infection. Pathogenic pathways of nervous system involvement in COVID-19 remain poorly understood. Neuropathological studies highlighted the possible role of sepsis and hypoxia, endothelial infection / dysfunction, inflammation and immune-mediated disease. While the presence of SARS-CoV-2 in the brain was confirmed in some COVID-19 patients, there were no definite evidence to support its direct pathogenicity on brain parenchyma. Conclusion: Neurological involvement in COVID-19 is frequent and include various manifestations. Most of them are encephalopathies and strokes, probably linked to viral sepsis, hypoxia and/or endotheliitis. A wide range of post infectious disorders were also reported, such as encephalitis and Guillain-Barré syndrome. To date no studies demonstrated definite evidence of a direct pathogenicity of SARS-CoV-2 on brain. . Une première étude rétrospective sur 214 patients hospitalisés rapportait l'existence de symptômes neurologiques dans 36% des cas 2 . A la même période ont été publiés les premiers cas d'encéphalites 3, 4 . Depuis, de nombreuses autres atteintes neurologiques aiguës associées à l'infection par SARS-CoV-2 ont été décrites, comme les accidents vasculaires cérébraux, les encéphalopathies ou les syndromes de Guillain-Barré 5 . Plus récemment, l'attention est portée sur la persistance ou l'apparition de symptômes chroniques plusieurs semaines après l'infection initiale, dont des céphalées, des troubles de l'humeur et des troubles cognitifs 6 . L'objectif est ici d'exposer les connaissances actuelles sur les manifestations neurologiques associées au COVID-19, leur prévalence, leurs caractéristiques et les principaux mécanismes physiopathologiques suspectés. Des symptômes et des signes neurologiques non spécifiques sont identifiés chez 15 à 73% des patients COVID hospitalisés 2,7-9 . Ces études multicentriques rétrospectives ont rapporté une altération de l'état mental (définie comme une altération aiguë de la personnalité, du comportement, de la cognition ou de la conscience, 8 Extrapulmonary manifestations of COVID Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features A first case of meningitis/encephalitis associated with SARS-Coronavirus-2 Neurological associations of COVID-19 Living with Covid19 [Internet]. National Institute for Health Research Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry Imaging in Neurological Disease of Hospitalized COVID-19 Patients: An Italian Multicenter Retrospective Observational Study patients in Washington State Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study COVID-19-associated acute necrotizing myelitis Miller Fisher Syndrome and polyneuritis cranialis in COVID-19 Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions Immune-mediated neurological syndromes in SARS-CoV-2-infected patients Cerebrovascular disease in patients with COVID-19: neuroimaging, histological and clinical description Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study Utility of hyposmia and hypogeusia for the diagnosis of COVID-19 Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) COVID-19-related encephalopathy responsive to high doses glucocorticoids Cytokine release syndrome-associated encephalopathy in patients with COVID-19 encephalitis/encephalopathy with a reversible splenial lesion Neurologic and neuroimaging findings in COVID-19 patients: A retrospective multicenter study Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 Infection Report of EEG Finding on Critically Ill Patients with COVID -19 COVID-19 associated encephalopathy: Is there a specific EEG pattern? Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology Neuropathological Features of Covid-19 Correlates of critical illness-related encephalopathy predominate postmortem COVID-19 neuropathology Neuropathologic features of four autopsied COVID-19 patients Microvascular injury and hypoxic damage: emerging neuropathological signatures in COVID-19 COVID-19-White matter and globus pallidum lesions: Demyelination or small-vessel vasculitis? COVID-19 Neurologic Complication with CNS Vasculitis-Like Pattern Early evidence of pronounced brain involvement in fatal COVID-19 outcomes Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: Consensus Statement of the International Encephalitis Consortium The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings Generalized myoclonus in COVID-19 Acute hypokineticrigid syndrome following SARS-CoV-2 infection Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection Cerebrospinal fluid features in SARS-CoV Acute disseminated encephalomyelitis after SARS-CoV-2 infection COVID-19 encephalopathy: detection of antibodies against SARS-CoV-2 in CSF Neuropathology of patients with COVID-19 in Germany: a post-mortem case series Neuroinvasion of SARS-CoV-2 in human and mouse brain SARS-CoV-2 targets neurons of 3D human brain organoids Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster? Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry More that ACE2? NRP1 may play a central role in the underlying pathophysiological mechanism of olfactory dysfunction in COVID-19 and its association with enhanced survival