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COVID-19 Clinical Features

What are the Neurological Manifestations of COVID-19?

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BACKGROUND AND PURPOSE:

  • Mao et al. (JAMA Neurology, 2020) report on the neurological manifestations of patients with COVID-19

METHODS:

  • Retrospective, observational case series (January 16, 2020, to February 19, 2020)
  • Setting
    • 3 designated COVID-19 care centers in Wuhan, China  
  • Participants
    • Consecutive hospitalized patients with laboratory-confirmed diagnosis of COVID-19
  • Study design
    • Clinical characteristics were obtained from electronic medical records
      • Data on neurologic symptoms were checked by 2 trained neurologists
    • Neurologic manifestations were classified in to 3 categories
      • CNS manifestations: Dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure
      • Peripheral nervous system manifestations: Taste impairment, smell impairment, vision impairment, and nerve pain
      • Skeletal muscular injury manifestation | Defined as a skeletal muscle pain and elevated serum creatine kinase level >200 U/L

RESULTS:

  • 214 COVID-19 patients were analyzed
    • Mean age: 52.7 years | Males 40.7%
  • Non-severe infection: 58.9% | Severe infection: 41.1%
  • Neurological manifestation: 36.4% (78 patients)
    • CNS: 24.8%
    • PNS: 8.9%
    • Skeletal muscle injury: 10.7%
  • Manifestations of neurologic manifestations include
    • Acute CVA
    • Ischemic stroke
    • Cerebral hemorrhage
    • Impaired consciousness
  • Patients with severe disease
    • Were older: 58.2 vs 48.9 years (P < .001)
    • Had more underlying disorders (e.g. hypertension): 47.7% vs 32.5% (P=0.03)
    • Showed fewer typical symptoms of COVID-19, such as
      • Fever: 45.5% vs 73% (P < .001)
      • Dry cough: 34.1% vs 61.1% (P < .001)
  • Patients with more severe infection were more likely to have neurologic manifestations
    • Acute cerebrovascular disease: 5.7% vs 0.8% in non-severe
    • Impaired consciousness: 14.8% vs 2.4% in non-severe
    • Skeletal muscle injury: 19.3% vs 4.8% in non-severe

CONCLUSION:

  • Patients with COVID-19 can have neurological manifestations, such as acute cerebrovascular diseases and impaired consciousness
  • Neurological manifestations are more common with severe forms of COVID-19

The authors state

During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission

Learn More – Primary Sources:

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

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Related ObG Topics:

Loss of Taste and Smell: Key Symptoms of COVID-19 Infection
COVID-19: The Importance of GI Symptoms and Elevated LFTs
Characteristics and Outcomes for 5700 COVID-19 Patients Hospitalized in the New York City Area

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