Characteristics, onset, and evolution of neurological symptoms in patients with COVID-19

Abstract

Background A wide range of neurological manifestations has been described in COVID-19. Methods In this nationwide retrospective observational study, patients in Tunisia diagnosed with COVID-19 between the 2nd of March and the 16th of May 2020 were contacted by telephone. We collected demographic and clinical data and specified characteristics and evolution of main neurological symptoms. Results Of 1034 confirmed COVID-19 patients, 646 were included (mean age 42.17 years old) and 466 (72.1%) had neurological symptoms. Neurological symptoms were isolated 22.7% ( n = 106). Headache was the most frequent neurological symptom ( n = 279, 41.1%): mainly frontotemporal ( n = 143, 51.1%) and mild or moderate ( n = 165, 59.1%). When associated with fever ( n = 143, 51.3%), headache was more likely to be severe and present at onset. Recovery was reported in 83.2%. Smell and taste impairment were found in 37.9% ( n = 245) and 36.8% ( n = 238) respectively. Among them, 65.3% (156/239) were anosmic and 63.2% (146/231) were ageusic. A complete improvement was found in 72.1% (174/240) of smell impairment and in 76.8% (179/233) of taste impairment. Myalgia ( n = 241, 37.3%) and sleep disturbances ( n = 241, 37.3%) were also frequent. Imported cases had more neurological symptoms ( p = 0.001). In 14.5%, neurological symptoms preceded the respiratory signs (RS). RS were associated with more frequent ( p = 0.006) and numerous ( p < 0.001) neurological symptoms. Conclusions Neurological symptoms in COVID-19 are frequent, can be isolated and present at onset. A total recovery is the most recorded outcome. RS are predictive of neurological symptoms. Studies in to virus and host genetics should be considered to understand the different phenotypes.

Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea

“…In previous studies on the neurological aspects of COVID-19, the incidence of neurological manifestations (including nonspecific symptoms) has varied widely, from 36% to 72%. 2 11 12 13 14 Similar to the present findings, the most common symptoms reported previously were headache, myalgia, smell and taste impairment, and impaired consciousness. A recent systematic review found that the symptoms of headache, dizziness, smell dysfunction, and impaired consciousness occurred in 20.1, 6.8, 59.2, and 5.1% of patients, respectively.…”

“…A study from Wuhan found that some patients with COVID-19 had neurological symptoms as their presenting manifestations, 2 and one observational study found that neurological symptoms preceded respiratory symptoms in 14.5% of patients with COVID-19 and were the only symptoms of the disease in 22.7%. 12 In another observational study investigating the initial symptoms of COVID-19, neurological symptoms were found in 9.7% of the patients. 48 In another study, the onset of anosmia was noted early in 73% of the patients prior to the diagnosis of COVID-19.…”

“…The present findings are very similar to those of a study using structured surveys to obtain data that was performed in Tunisia. 12 This study was a single-center study that included only hospitalized patients, and so the findings may not be generalizable to the overall COVID-19 patient population. Further large, prospective studies are needed to establish the details of the neurological characteristics of COVID-19.…”

Neurological update: COVID-19

“…Anosmia and ageusia are common symptoms of COVID-19 [36], and the olfactory epithelium are some of the earliest cell types to be infected [37]. Theoretically, if the virus can pass to olfactory sensory neurons, it could travel across the cribriform plate to arrive at the olfactory bulb, and subsequently access other brain regions [34].…”

Neurological manifestations in patients with symptomatic COVID-19 admitted to the Bafoussam Regional Hospital, Cameroon

“…To date, there is no definitive evidence supporting the contribution of direct neuronal infection to the development of encephalopathy, delirium, and other neurological manifestations observed in patients with COVID-19 [ 12 ]. In Northern Africa, neurological manifestations of COVID-19 have been reported in several hospital-based cross-sectional studies [ 13 - 15 ]. On the contrary, apart from a few case reports [ 16 - 18 ], data on the neurological manifestations of COVID-19 in sub-Saharan Africa are scarce.…”