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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