Background: To study the nature and frequency of occurrence of “significant” neurological complications in coronavirus disease MESHD-2019 (COVID-19) via a systematic review of the literature.Methods: We screened all articles resulting from a search of PubMed, Cochrane, Google Scholar and Scopus, using the keywords "COVID-19 and CNS", "SARS-CoV-2 and CNS”, “COVID-19 and neurological manifestation”, “SARS2 and neurological manifestation” and “COVID-19 and Brain” looking for reports of significant neurological manifestations that would potentially have an impact on the outcome.Results: Twenty-six articles met the inclusion criteria. The significant neurological diagnoses reported were stroke MESHD stroke HP, Guillain Barre Syndrome MESHD (GBS) and its variants, encephalitis MESHD encephalitis HP, seizures MESHD seizures HP, acute hemorrhagic necrotizing encephalopathy, acute HP acute disseminated encephalomyelitis MESHD (ADEM) and transverse myelitis MESHD myelitis HP. Although stroke MESHD stroke HP, predominantly ischemic, was observed in ~ 6% of COVID-19 patients from Wuhan, China, mortality in this cohort was 38%. Of the 24 pooled patients with reports of etiology, 17 had large vessel occlusions. GBS occurred in 5/1200 (0.4%) of the COVID-19 cohort from Italy. One of the six reported encephalitis MESHD encephalitis HP cases, the ADEM case and the report of transverse myelitis MESHD myelitis HP do not have data for conclusive diagnosis.Conclusion: The most frequent significant neurological association with COVID-19 is stroke MESHD stroke HP, predominantly ischemic. In a cohort from Wuhan, China, this was as frequent as ~ 6%, with a 38% mortality. Most common reported etiology is large vessel occlusion. Other reported significant neurological complications are GBS/variants, encephalitis MESHD encephalitis HP, seizures MESHD seizures HP and acute hemorrhagic necrotizing encephalopathy HP. The reports of ADEM and transverse myelitis MESHD myelitis HP lacked diagnostically conclusive data.