Objective:

To systematically review and delineate neurological manifestations in individuals with confirmed Wiskott–Aldrich syndrome (WAS), emphasizing the significance of these manifestations for patient care.

Key Findings:

• 26 studies involving 32 individuals were analyzed, predominantly pediatric (78.1%).
• Median age at WAS diagnosis was 0.4 years; neurological manifestations appeared at a median of 3.0 years later, with statistical significance (p = 0.018).
• Neurological manifestations included brain hemorrhagic (8), immune-mediated (6), infectious (6), and neoplastic (12) cases.
• Case-fatality rates varied: 100% in infectious, 75% in neoplastic, 62.5% in hemorrhagic, and 0% in immune-mediated cases.
• Higher mortality was observed in non-transplant patients (63.6%) compared to transplant patients (50.0%).

Interpretation:

Neurological manifestations in WAS show significant age-dependent variations and high case-fatality rates, particularly in infectious and neoplastic cases, highlighting the need for increased neurological awareness and documentation in clinical practice.

Limitations:

• The review is based on case reports, limiting the ability to generalize findings and introducing potential biases.
• Variability in the quality of included studies may affect the robustness of conclusions.

Conclusion:

The findings underscore the importance of recognizing and documenting neurological symptoms in WAS to improve patient outcomes and inform future research directions.