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July 14, 2020; 95 (2) Views & Reviews

Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19

Collin Herman, Kirby Mayer, Aarti Sarwal
First published April 28, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009673
Collin Herman
From the Department of Neurology (C.H., A.S.), Wake Forest Baptist Medical Center, Winston Salem, NC; and Department of Physical Therapy (K.M.), University of Kentucky College of Health Sciences, Lexington.
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Kirby Mayer
From the Department of Neurology (C.H., A.S.), Wake Forest Baptist Medical Center, Winston Salem, NC; and Department of Physical Therapy (K.M.), University of Kentucky College of Health Sciences, Lexington.
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Aarti Sarwal
From the Department of Neurology (C.H., A.S.), Wake Forest Baptist Medical Center, Winston Salem, NC; and Department of Physical Therapy (K.M.), University of Kentucky College of Health Sciences, Lexington.
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Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19
Collin Herman, Kirby Mayer, Aarti Sarwal
Neurology Jul 2020, 95 (2) 77-84; DOI: 10.1212/WNL.0000000000009673

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Abstract

Objective The emergence of coronavirus disease 2019 (COVID-19) presents a challenge for neurologists caring for patients with preexisting neurologic conditions hospitalized for COVID-19 or for evaluation of patients who have neurologic complications during COVID-19 infection. We conducted a scoping review of the available literature on COVID-19 to assess the potential effect on neurologists in terms of prevalent comorbidities and incidence of new neurologic events in patients hospitalized with COVID-19.

Methods We searched MEDLINE/PubMed, CINAHL (EBSCO), and Scopus databases for adult patients with preexisting neurologic disease who were diagnosed and hospitalized for COVID-19 or reported incidence of secondary neurologic events following diagnosis of COVID-19. Pooled descriptive statistics of clinical data and comorbidities were examined.

Results Among screened articles, 322 of 4,014 (8.0%) of hospitalized patients diagnosed and treated for COVID-19 had a preexisting neurologic illness. Four retrospective studies demonstrated an increased risk of secondary neurologic complications in hospitalized patients with COVID-19 (incidence of 6%, 20%, and 36.4%, respectively). Inconsistent reporting and limited statistical analysis among these studies did not allow for assessment of comparative outcomes.

Conclusion Emerging literature suggests a daunting clinical relationship between COVID-19 and neurologic illness. Neurologists need to be prepared to reorganize their consultative practices to serve the neurologic needs of patients during this pandemic.

Glossary

COVID-19=
coronavirus disease 2019;
ICU=
intensive care unit;
PPE=
personal protective equipment

The recent outbreak of SARS-CoV-2, designated “coronavirus disease 2019 (COVID-19)” by the World Health Organization (WHO), was officially declared a pandemic on March 11, 2020, and is expected to continue to spread globally.1,2 The disease spectrum ranges from largely asymptomatic infections with or without mild pneumonia to severe hypoxic respiratory failure with multiorgan dysfunction and/or shock.2 COVID-19 is spread through droplets with a highly variable incubation period (5–14 days) with a case fatality rate of 1.8%–3.4%.3 The highly transmissible nature, asymptomatic carriage, and the wide spectrum of illness make this disease challenging for health care systems. Neurologists face the daunting task of caring for patients with preexisting neurologic disease who contract the virus, infected individuals who present with neurologic emergencies requiring neurologic consultation, and patients with COVID-19 who develop secondary neurologic complications such as ischemic stroke, seizures, or encephalopathy during the course of their illness.4,–,6 This necessitates personal protective equipment (PPE) for emergent neurologic consultations as well as consideration of telehealth alternatives to reduce physical exposure for neurologists. A recent meta-analysis examining the prevalence of comorbidities in COVID-19 infections surprisingly reported no neurologic comorbidities and risk stratification scores that qualify patients for therapies like chloroquine have not yet incorporated neurologic illness.7,8 Hence, we conducted a scoping review of the available literature on COVID-19 to assess the prevalence of patients with preexisting neurologic disease and the incidence of neurologic complications following COVID-19 diagnosis.

Methods

The authorship team designed a primary literature search to understand the incidence of patients with preexisting neurologic disease who were diagnosed with and hospitalized for COVID-19 or had reported incidence of secondary neurologic events following diagnosis of COVID-19.

Eligibility criteria

Research studies were selected for inclusion if they met the following criteria: (1) adult patients (aged ≥18 years); (2) diagnosed and received inpatient treatment for COVID-19; and (3) reported data on preexisting neurologic comorbidities or neurologic events occurring during the course of the illness. Additional articles were included through a gray search via Google search engine and manual review of references listed articles to find relevant articles. Studies were not restricted according to design and had to be available in the English language. Because of the rapidly evolving state of the COVID-19 pandemic, non–peer-reviewed articles available via pre-acceptance open access were included. We did not find any pediatric literature relevant to this review.

Information sources and search strategy

We searched electronic databases: MEDLINE/PubMed, CINAHL (EBSCO), and Scopus from January 1, 2020, to April 15, 2020. We summarize the comprehensive search strategies with Boolean operators in table 1.

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Table 1

Electronic database search strategy

Study selection and data collection

At least 2 independent reviewers independently screened all publications, including title and abstract, to determine whether studies met the inclusion criteria. After agreement on included articles, 1 reviewer independently retrieved comorbidity and clinical variables from the selected articles.

Statistical analysis

Pooled descriptive statistics of clinical data and comorbidities were examined.9 The primary goal of this scoping review was to report on the incidence of neurologic comorbidities and occurrence of secondary neurologic events; as such, meta-analysis was not performed.

Results

Preexisting neurologic disease and COVID-19 diagnosis

Articles were screened by title and abstract. Twenty-two studies met the inclusion criteria (figure). Twenty retrospective studies,6,10,–,28 1 prospective observational trial,29 and 1 randomized controlled trial30 were included. Twenty studies were conducted in China, 1 in Italy, and 1 in France. In total, 4,014 patients were included, with a mean age of 55.6 ± 8.4 years and 57% male predominance. The pooled percentage for having a preexisting neurologic disease was 8.0% (n = 322/4,014, range of 0%–40% for individual studies; table 2). The presence of preexisting neurologic disease was frequently not specified and grouped only as cerebrovascular disease, nervous system disease, or history of prior stroke. In addition, 5 studies grouped cerebrovascular disease and cardiovascular disease together, potentially inflating the incidence.17,19,–,21

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Figure PRISMA flow diagram of the selection process
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Table 2

Prevalence of preexisting neurologic diseases for patients hospitalized for COVID-19

We found headache to be a commonly reported symptom at presentation as it was mentioned in 22 articles. However, headache was not reported as a comorbidity and hence not included. Other neurologic comorbidities rarely mentioned in screened articles included dementia and Parkinson disease (table 1). We did not find a mention of anosmia in any searched scientific literature. We attempted but were unable to assess comparative outcomes from COVID-19 in patients with preexisting neurologic disease due to inconsistency in reporting, potential overlap in multiple studies reporting similar patients, and limited statistical analysis of the included studies. However, a few studies assessed the risk of worse patient outcomes and considered demographic and clinical variables including comorbidities as predictors in the analysis.

Among all patients with COVID-19, those requiring treatment in an intensive care unit (ICU) were more likely to be older, male sex, and have an underlying comorbidity, specifically cerebrovascular disease (16.7% vs 1.0%).12 Similarly, patients who did not have clinical improvement or remission of symptoms within the first 10 days of hospitalization had higher incidence of preexisting cerebrovascular disease (8.2% vs 0%).11 Patients with COVID-19 and underlying cerebrovascular disease were also more likely to develop acute respiratory distress syndrome (11% vs 0%) in a cohort of 109 patients in Wuhan.18 Univariate analysis in a prospective cohort of 179 patients with COVID-19 pneumonia showed that preexisting cardiovascular or cerebrovascular disease was predictive of mortality (odds ratio = 11.059, 95% confidence interval = 4–30).29 We also observed a reported coincidence of Parkinson disease in COVID-19 similar to previously reported with SARS-CoV.15,31 This correlation has been previously explored in several publications.32

Incidence of secondary neurologic disease after COVID-19

We found 10 publications reporting secondary neurologic events in patients diagnosed with COVID-19 (table 3). Four retrospective studies demonstrated a relationship between secondary neurologic events and treatment of COVID-19. One study demonstrated that 36% of 214 patients hospitalized for COVID-19 developed neurologic symptoms or secondary cerebral events.20 Another study demonstrated that 6% of 221 patients hospitalized for COVID-19 had an acute cerebrovascular event (ischemic stroke, cerebral thrombosis, and/or cerebral hemorrhage) while undergoing treatment.21 Hypoxic ischemic encephalopathy was reported in 20% of patients in another case series.24 A French study reported confusion in 65% patients and diffuse corticospinal signs in 67% patients during hospitalization. This study also reported dysexecutive syndrome in 33% of patients at discharge. Among 13 patients undergoing brain MRI in this study, 3 had acute/subacute ischemic strokes, 11 had bilateral frontotemporal hypoperfusion, and 8 had leptomeningeal enhancement with negative CSF RT-PCR.28 Older age, more severe illness, and underlying cardiovascular or cerebrovascular disease were risk factors for secondary cerebrovascular events.20,21 Further case reports have described various neurologic illnesses including acute necrotizing encephalopathy, ischemic strokes, seizures, intracranial hemorrhage, Guillain-Barre syndrome, and meningoencephalitis.22,33,–,37

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Table 3

Incidence and risk of secondary neurologic events during respiratory coronavirus infections

Discussion

These data suggest that patients with underlying neurologic impairment are vulnerable to more severe illness when infected with COVID-19. We saw a trend toward patients with preexisting cerebrovascular disease having higher risk of ICU admission as well as overall mortality. In addition, patients hospitalized with COVID-19 showed a 6%–36% incidence of neurologic events during the course of their illness.

Whether the trend toward worse outcomes is related to vulnerability from neurologic disorders or the presence of other cardiovascular comorbidities leading to neurologic complications in these patients is difficult to discern without further data. The neurotropism of the coronavirus itself is being investigated as a possible mechanism behind the higher incidence of brainstem-mediated cardiopulmonary complications in patients who have more severe disease.38,39

Experimental data including autopsy samples of human brain tissue suggest a neuroinvasive potential of respiratory pathogens including coronaviruses in patients with and without preexisting neurologic disease.40,–,42 Published case series of other corona respiratory viruses like Middle East respiratory syndrome-related coronavirus (MERS-CoV) and severe acute respiratory syndrome-related coronavirus (SARS-CoV) in prior years have listed similar neurologic complications including intracranial hemorrhage, ischemic stroke, polyneuropathy, Bickerstaff encephalitis, and Guillain-Barre syndrome.43

Further data on the vulnerability of patients with neurologic illness may be impactful in targeting this population for proactive viral screening. Risk stratification scores that identify patients at high risk of deterioration or that qualify patients for empiric therapies like hydroxychloroquine also need to reconsider adding patients with cerebrovascular disease.8

The burden of neurologic events occurring in hospitalized patients demonstrates the need for appropriate infrastructure to facilitate neurologic assessments in this population that may be deterred by the cumbersome nature of protection required for clinical assessments. This infrastructure may include a robust supply of PPE for neurologists to assess patients, telemedicine alternatives for remote assessment of bedside examination, and protocols for transporting these patients for neuroimaging including emergent evaluation for cerebrovascular disease.

This scoping review has several limitations. Our analyses are limited by small sample sizes, even smaller incidences of neurologic comorbidities, lack of long-term follow-up, and the possibility of overlap in populations described in reviewed articles potentially biasing the results. The studies included in this scoping review also have inherent bias based on the study designs. The retrospective nature of most of the included studies potentially presents selection and presentation bias. Retrospective studies are subject to misclassification bias with limited ability to control for all potential confounders. In addition, retrospective studies require large sample sizes to generate statistical power to determine different in-study end points. We did not specifically perform a risk of bias assessment in this scoping review, but instead choose to focus on the overall prevalence. Lack of neurologic history reported in medical records by an overstretched health care system, lack of exhaustive reporting of neurologic comorbidities in acutely reported publications, and challenges of neurologic assessments or neuroimaging in patients with COVID-19 may have contributed to the lower reported incidence of neurologic comorbidities or secondary neurologic events in hospitalized patients. Two meta-analyses reporting comorbidities in COVID-19 and MERS-CoV failed to report neurologic comorbidities, highlighting challenges of collecting such data.7,44 We were unable to perform meta-analysis or predict worse outcomes based on comorbidity status.

Conclusions

The culmination of studies indicates a daunting clinical relationship between COVID-19 and secondary neurologic complications and needs a concerted effort by neurologists to reorganize consultative practices to serve the neurologic needs of patients during this pandemic. More sensitive data extraction measures and comprehensive clinical documentation are required to better understand the prevalence of neurologic comorbidities and preexisting neurologic disorders in patients with COVID-19.

Study funding

No targeted funding reported.

Disclosure

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Appendix Authors

Table

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received March 25, 2020.
  • Accepted in final form April 22, 2020.
  • © 2020 American Academy of Neurology

References

  1. 1.↵
    Coronavirus Disease 2019 (COVID-19) Situation Report-51. Available at who.int. Accessed March 20, 2020.
  2. 2.↵
    1. Gorbalenya AE,
    2. Baker SC,
    3. Baric RS, et al
    . The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020;5:536–544.
    OpenUrl
  3. 3.↵
    1. Lauer SA,
    2. Grantz KH,
    3. Bi Q, et al
    . The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020:M20–M0504.
  4. 4.↵
    1. Bai Y,
    2. Yao L,
    3. Wei T, et al
    . Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020;323:1406–1407.
    OpenUrlPubMed
  5. 5.↵
    1. Li Q,
    2. Guan X,
    3. Wu P, et al
    . Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. New Engl J Med 2020;382:1199–1207.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Guan WJ,
    2. Ni ZY,
    3. Hu Y, et al
    . Clinical characteristics of 2019 novel coronavirus infection in China. New Engl J Med 2020;382:1708–1720.
    OpenUrlPubMed
  7. 7.↵
    1. Yang J,
    2. Zheng Y,
    3. Gou X, et al
    . Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: a systematic review and meta-analysis. Int J Infect Dis 2020;94:91–95.
    OpenUrlPubMed
  8. 8.↵
    1. Caramelo F,
    2. Ferreira N,
    3. Oliveiros B
    . Estimation of risk factors for COVID-19 mortality—preliminary results. medRxiv 2020. doi:10.1101/2020.02.24.20027268.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Wan X,
    2. Wang W,
    3. Liu J,
    4. Tong T
    . Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014;14:135.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Wu C,
    2. Chen X,
    3. Cai Y, et al
    . Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med Epub 2020 Mar 13.
  11. 11.↵
    1. Mo P,
    2. Xing Y,
    3. Xiao Y, et al
    . Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis 2020.
  12. 12.↵
    1. Wang D,
    2. Hu B,
    3. Hu C, et al
    . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323:1061–1069.
    OpenUrlCrossRefPubMed
  13. 13.↵
    1. Shi H,
    2. Han X,
    3. Jiang N, et al
    . Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;20:425–434.
    OpenUrlPubMed
  14. 14.↵
    1. Wang L,
    2. Gao YH,
    3. Lou LL,
    4. Zhang GJ
    . The clinical dynamics of 18 cases of COVID-19 outside of Wuhan, China. Eur Respir J 2020;55:2000398.
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. Deng SQ,
    2. Peng HJ
    . Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China. J Clin Med 2020;9:E575.
    OpenUrl
  16. 16.↵
    1. Wang W,
    2. Tang J,
    3. Wei F
    . Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 2020;92:441–447.
    OpenUrlCrossRefPubMed
  17. 17.↵
    1. Chen N,
    2. Zhou M,
    3. Dong X, et al
    . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–513.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Liu Y,
    2. Sun W,
    3. Li J, et al
    . Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019. medRxiv 2020. doi:10.1101/2020.02.17.20024166.
    OpenUrlAbstract/FREE Full Text
  19. 19.↵
    1. Chen J,
    2. Qi T,
    3. Liu L, et al
    . Clinical progression of patients with COVID-19 in Shanghai, China. J Infect 2020;80:e1–e6.
    OpenUrl
  20. 20.↵
    1. Mao L,
    2. Wang M,
    3. Chen S, et al
    . Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. JAMA Neurol 2020;e201127.
  21. 21.↵
    1. Li Y,
    2. Mengdie W,
    3. Zhou Y, et al
    . Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study SSRN January 2020.
  22. 22.↵
    1. Filatov A,
    2. SP,
    3. Hindi F,
    4. Espinosa P
    . Neurological complications of coronavirus disease (COVID-19): encephalopathy. Cureus 2020;12:e7352.
    OpenUrlCrossRefPubMed
  23. 23.↵
    1. Onder G,
    2. Rezza G,
    3. Brusaferro S
    . Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020;323:1775–1776.
    OpenUrl
  24. 24.↵
    1. Chen T,
    2. Wu D,
    3. Chen H, et al
    . Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020;368:m1091.
    OpenUrlAbstract/FREE Full Text
  25. 25.↵
    1. Xu XW,
    2. Wu XX,
    3. Jiang XG, et al
    . Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 2020;368:m606.
    OpenUrlAbstract/FREE Full Text
  26. 26.↵
    1. Du Y,
    2. Tu L,
    3. Zhu P, et al
    . Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study. Am J Respir Crit Care Med 2020.
  27. 27.↵
    1. Guo W,
    2. Li M,
    3. Dong Y, et al
    . Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev 2020:e3319.
  28. 28.↵
    1. Helms J,
    2. Kremer S,
    3. Merdji H, et al
    . Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 2020.
  29. 29.↵
    1. Du RH,
    2. Liang LR,
    3. Yang CQ, et al
    . Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J 2020;55:2000524.
    OpenUrlAbstract/FREE Full Text
  30. 30.↵
    1. Cao B,
    2. Wang Y,
    3. Wen D, et al
    . A trial of lopinavir–ritonavir in adults hospitalized with severe covid-19. N Engl J Med 2020;382:1787–1799.
    OpenUrlPubMed
  31. 31.↵
    1. Moni MA,
    2. Liò P
    . Network-based analysis of comorbidities risk during an infection: SARS and HIV case studies. BMC Bioinformatics 2014;15:333.
    OpenUrlCrossRefPubMed
  32. 32.↵
    1. Fazzini E,
    2. Fleming J,
    3. Fahn S
    . Cerebrospinal fluid antibodies to coronavirus in patients with Parkinson's disease. Mov Disord 1992;7:153–158.
    OpenUrlCrossRefPubMed
  33. 33.↵
    1. Poyiadji N,
    2. Shahin G,
    3. Noujaim D,
    4. Stone M,
    5. Patel S,
    6. Griffith B
    . COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology 2020:201187.
  34. 34.↵
    1. Zhai P,
    2. Ding Y,
    3. Li Y
    . The impact of COVID-19 on ischemic stroke: a case report, 31 March 2020, PREPRINT (version 1). Res Square 2020.
  35. 35.↵
    1. Karimi N,
    2. Sharifi Razavi A,
    3. Rouhani N
    . Frequent convulsive seizures in an adult patient with COVID-19: a case report. Iran Red Crescent Med J 2020;22:e102828.
    OpenUrl
  36. 36.↵
    1. Sharifi-Razavi A,
    2. Karimi N,
    3. Rouhani N
    . COVID 19 and intra cerebral hemorrhage: causative or coincidental. New Microbes and New Infections 2020;35:100669.
    OpenUrl
  37. 37.↵
    1. Moriguchi T,
    2. Harii N,
    3. Goto J, et al
    . A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020;94:55–58.
    OpenUrlCrossRefPubMed
  38. 38.↵
    1. Li YC,
    2. Bai WZ,
    3. Hashikawa T
    . The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020;92:552–555.
    OpenUrl
  39. 39.↵
    1. Baig AM,
    2. Khaleeq A,
    3. Ali U,
    4. Syeda H
    . Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci 2020;11:995–998.
    OpenUrlPubMed
  40. 40.↵
    1. Bohmwald K,
    2. Gálvez NMS,
    3. Ríos M,
    4. Kalergis AM
    . Neurologic alterations due to respiratory virus infections. Front Cell Neurosci 2018;12:386.
    OpenUrlCrossRefPubMed
  41. 41.↵
    1. Arbour N,
    2. Day R,
    3. Newcombe J,
    4. Talbot PJ
    . Neuroinvasion by human respiratory coronaviruses. J Virol 2000;74:8913.
    OpenUrlAbstract/FREE Full Text
  42. 42.↵
    1. Xu J,
    2. Zhong S,
    3. Liu J, et al
    . Detection of severe acute respiratory syndrome coronavirus in the brain: potential role of the chemokine mig in pathogenesis. Clin Infect Dis 2005;41:1089–1096.
    OpenUrlCrossRefPubMed
  43. 43.↵
    1. Umapathi T,
    2. Kor AC,
    3. Venketasubramanian N, et al
    . Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). J Neurol 2004;251:1227–1231.
    OpenUrlCrossRefPubMed
  44. 44.↵
    1. Badawi A,
    2. Ryoo SG
    . Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. Int J Infect Dis 2016;49:129–133.
    OpenUrlPubMed
  45. 45.
    1. Zhao H,
    2. Shen D,
    3. Zhou H,
    4. Liu J,
    5. Chen S
    . Guillain-Barre syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol 2020;19:383–384.
    OpenUrlCrossRefPubMed

Letters: Rapid online correspondence

  • Reader response: Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19
    • Jerome H. Chin, Adjunct Professor, Department of Neurology, NYU Langone Health
    Submitted May 10, 2020
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