This systemic review aims to provide an overview of the neurological signs, symptoms, and neuroimaging findings in patients with Nipah virus infection.

The PRISMA guideline was used to design this systemic review. Medical subject headings (MeSH), keywords, and specific phrases related to the topic were introduced in academic databases to collect papers that met our eligibility criteria. Papers excluded were gray literature, unpublished papers, and those not related to the topic. Subsequently, every paper was reviewed with the JBI checklist or NewCastle-Ottawa scale for quality appraisal. Neurological manifestations and neuro-imaging findings in patients with NiV infection were listed and quantified.

A total of eight papers with 374 patients were analyzed. These included cross-sectional, retrospective, and prospective cohort studies, which were used to calculate the frequency of the neurological features reported in NiV infection. Pupillary abnormalities (52.13%), cranial neuropathies (41.43%), hyporeflexia (40.73%), and myoclonus (35.04%) were the most frequent neurological signs. On the other hand, the most repeated symptoms were a depressed level of consciousness (85.19%), headache (72.65%), dizziness (41.12%), and seizures (23.93%). Additionally, brainstem hyperintensities (61.54%), cortical hyperintensities (43.48%), scattered deep white matter hyperintensities (40.94%), and cerebellar hyperintensities (38.46%) were the most reported imaging findings.

Clinicians should be aware that NiV can infect the CNS and cause meningoencephalitis with a variety of focal, non-specific findings. Additional research is required to define further features, such as mortality and long-term complications.