A systematic review of neurological symptoms, signs, and neuroimaging findings in Nipah virus (NiV) infection

Abstract Aim This systematic review aims to provide a comprehensive overview of the neurological signs, symptoms, and neuroimaging findings in patients with Nipah virus infection as reported in the literature. Methods The authors systematically reviewed literature from PubMed, Scopus, EBSCO, and ScienceDirect that researches the neurological symptoms, signs, and neuroimaging findings in Nipah virus infection. Each author searched independently in a database in the time period of September 2024 to January 2025. Results The literature search yielded 4522 articles. After screening, the selection was narrowed to 10 papers suitable for the review, with 504 NiV-reported patients. Headache (63.89%), depressed level of consciousness (63.49%), and daytime somnolence (44.14%) were the most frequent neurological symptoms. On the other hand, the most repeated signs were pupillary abnormalities (54.05%), hyporeflexia (44.53%), and cranial neuropathies (36.21%). Additionally, brainstem hyperintensities (61.54%), cortical hyperintensities (43.48%), and scattered deep white matter hyperintensities (40.94%) were the most reported imaging findings. Conclusion NiV is a poorly known pathogen capable of being a hazard to the nervous system. Clinicians should be aware that NiV can infect the CNS and cause a multifocal encephalitis with a variety of non-specific findings.