What your doctor is reading on Medscape.com:
APRIL 16, 2020 — COVID-19 is strongly associated with neurologic manifestations, including acute cerebrovascular diseases, impaired consciousness, and skeletal muscle injury, new research shows.
As previously reported by Medscape Medical News, small case and anecdotal reports suggest possible neurologic symptoms of COVID-19, but this is the first study to back these observations with scientific evidence.
Investigators based in Wuhan, China, analyzed data from more than 200 adult patients with COVID-19 and found that 36.4% had neurologic manifestations. In addition, close to half of those with severe disease had neurologic symptoms, compared to roughly one third of those with less severe disease.
“During the epidemic 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,” the investigators, led by Bo Hu, MD, PhD, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, write.
The study was published online April 10 in JAMA Neurology.
Established clinical manifestations of COVID-19 include fever, cough, diarrhea, and fatigue, but “it has not been reported that patients with COVID-19 had any neurologic manifestations,” the authors note.
To examine whether the virus can present with neurologic manifestations, the researchers analyzed electronic health records of 214 consecutive hospitalized patients (mean [SD] age 52.7 [15.5] years, 40.7% male), who attended one of three specialized COVID-19 care centers in Wuhan between January 16 and February 19.
Using the American Thoracic Society guidelines for community-acquired pneumonia, patients were categorized as having either severe or nonsevere illness. Based on this categorization, 41.1% of patients had severe infection and 58.9% had nonsevere infection.
Those with severe infection were more likely to be older (mean [SD] age 58.2 [15.0] vs 48.9 [14.7] years; P < .001) and to have other underlying disorders such as hypertension and fewer “typical” COVID-19 symptoms such as fever and dry cough.