Frequency of Neurological Presentations of Coronavirus Disease in Patients Presenting to a Tertiary Care Hospital During the 2019 Coronavirus Disease Pandemic

Iltaf, Samar; Fatima, Meraj; Salman, Salma; Salam, Jawwad-us; Abbas, Saira

doi:10.7759/cureus.9846

Cited by 32 publications

(37 citation statements)

References 19 publications

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“…In our study, 24.5% had neurological symptoms. Another study from Pakistan showed that 18.5% of patients with COVID-19 had neurological symptoms [10]. A study from Wuhan showed a much higher frequency (38%) of neurological symptoms [4].…”

Section: Resultsmentioning

confidence: 97%

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The Frequency of Neurological Symptoms in COVID-19 Patients at a Tertiary Care Hospital in Pakistan

Makda¹,

Kumar²,

Kumar³

et al. 2020

Cureus

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Introduction Coronavirus disease 2019 (COVID-19) primarily affects the pulmonary system and presents itself as shortness of breath, fever, and cough. However, it may affect other systems as well, including the nervous system. This study aimed to determine the frequency of neurological symptoms in COVID-19 patients and its association with the severity of the disease. Methods This cross-sectional study was conducted at a public sector tertiary care teaching hospital in Karachi, Pakistan, from April to July 2020. All patients with positive polymerase chain reaction (PCR) tests were included, except those with pre-existing neurological and psychiatric conditions. Results The most common neurological symptom was dizziness (17.5%), followed by headache (15.7%). Three (2.6%) patients had a stroke. Nine (7.8%) participants had a taste impairment, and another nine (7.8%) had a smell impairment. There was no significant difference in the frequency of neurological symptoms when severe and non-severe disease was compared. Conclusion Neurological symptoms are frequent in COVID-19. Care should be taken to identify them early. COVID-19 should be suspected in patients presenting with neurological abnormalities and should be included in the differential diagnosis to prevent further virus transmission.

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Section: Resultsmentioning

confidence: 97%

“…In this study, 12 (10.5%) participants had skeletal muscle injury. Muscle injury has been reported by various studies [4,10]. Muscle injury may result in an increase in creatine kinase, alanine, and aspartate transferase.…”

Section: Resultsmentioning

confidence: 99%

The Frequency of Neurological Symptoms in COVID-19 Patients at a Tertiary Care Hospital in Pakistan

Makda¹,

Kumar²,

Kumar³

et al. 2020

Cureus

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“…1 In another study including 350 patients with COVID-19, neurological manifestations were present in 18.9% and 3.1% had numbness or paresthesia. 23 A recent meta-analysis suggested that 80% of patients who have recovered from COVID-19 continue to have at least one symptom, sign, or abnormal laboratory parameter, beyond 2 weeks after the initial diagnosis. 24 Carfì et al 25 reported that 87% of hospitalised patients had at least one persisting symptom 60 days after the acute diagnosis of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

et al. 2021

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Background/AimsLong COVID is characterised by a range of potentially debilitating symptoms which develop in at least 10% of people who have recovered from acute SARS-CoV-2 infection. This study has quantified corneal sub-basal nerve plexus morphology and dendritic cell (DC) density in patients with and without long COVID.MethodsForty subjects who had recovered from COVID-19 and 30 control participants were included in this cross-sectional comparative study undertaken at a university hospital. All patients underwent assessment with the National Institute for Health and Care Excellence (NICE) long COVID, Douleur Neuropathique 4 (DN4) and Fibromyalgia questionnaires, and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), and total, mature and immature DC density.ResultsThe mean time after the diagnosis of COVID-19 was 3.7±1.5 months. Patients with neurological symptoms 4 weeks after acute COVID-19 had a lower CNFD (p=0.032), CNBD (p=0.020), and CNFL (p=0.012), and increased DC density (p=0.046) compared with controls, while patients without neurological symptoms had comparable corneal nerve parameters, but increased DC density (p=0.003). There were significant correlations between the total score on the NICE long COVID questionnaire at 4 and 12 weeks with CNFD (ρ=−0.436; p=0.005, ρ=−0.387; p=0.038, respectively) and CNFL (ρ=−0.404; p=0.010, ρ=−0.412; p=0.026, respectively).ConclusionCorneal confocal microscopy identifies corneal small nerve fibre loss and increased DCs in patients with long COVID, especially those with neurological symptoms. CCM could be used to objectively identify patients with long COVID.

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“…It remains unclear which factors are associated with increased risk of neurologic manifestation. It was suggested that neurological symptoms are more common in patients with severe disease [ 2 ] but not older age [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Research reports from Wuhan, China showed that neurological manifestations were present in 36.4% of patients and more common in patients with severe disease (45.5%) [ 2 ]. According to another study from Pakistan, neurological symptoms are present in 18.9% of SARS-Cov-2 patients [ 3 ]. The neurological symptoms reported were headache (6%), vertigo (3.4%), numbness/paresthesia (3.1%), altered consciousness (2%), hyposmia/anosmia (1.4%), and encephalitis (0.9%).…”

Section: Discussionmentioning

confidence: 99%

Peripheral Neuropathy as a Complication of SARS-Cov-2

Bureau¹,

Obeidat²,

Dhariwal³

et al. 2020

Cureus

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Previous reports have shown various neurological manifestations in about 36.4% of patients infected with SARS-Cov-2. However, peripheral neuropathy was only reported once before. A 40-year-old healthy woman presented with two weeks of cough, nasal congestion, sore throat, intermittent fevers, fatigue, and myalgia but no weakness. She tested positive for the SARS-Cov-2. Physical exam showed no neurologic deficit. Two weeks later, respiratory symptoms were improving but she developed sudden leg pain, numbness, and weakness. She described it as a “pain crisis”. Neurological exam showed bilateral symmetrical, non-ascending lower extremity weakness and normal, symmetric reflexes. She had normal magnetic resonance imaging of the brain and spine, spinal fluid analysis, serum studies including creatinine kinase and C-reactive protein. She had elevated lactate dehydrogenase, low serum copper (72.9 (ref: 80.0-155.0 ug/dL)) and low vitamin B6 (14.6 (ref: 20.0-125.0 nmol/L)). A diagnosis of SARS-Cov-2-associated peripheral neuropathy was considered. We pursued empiric treatment with intravenous steroids (1000 mg methylprednisolone for three days), followed by a total of 2 g/kg of intravenous immunoglobulins (IVIG) given over five days. Pain management was done with gabapentin and ketorolac. We replaced copper and vitamin B6. Six weeks later, she reported improvement and was closer to baseline, but she endorsed residual, exertional, mild bilateral lower extremity pain, numbness, and weakness. Previous reports of treatment of SARS-Cov-2-associated neuropathy included corticosteroids and IVIG. Our patient saw the most symptomatic improvement with gabapentin. In our case, the preserved reflexes, lack of ascending pattern, sudden onset of symptoms, and normal cerebrospinal fluid (CSF) argued against Guillain-Barre syndrome. Copper deficiency can result in myelopathy but not peripheral neuropathy, so is unlikely the sole explanation. Awareness and early treatment of peripheral neuropathy in SARS-Cov-2 can result in improved clinical outcomes for patients.

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Frequency of Neurological Presentations of Coronavirus Disease in Patients Presenting to a Tertiary Care Hospital During the 2019 Coronavirus Disease Pandemic

Abstract: Iltaf et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 32 publications

References 19 publications

The Frequency of Neurological Symptoms in COVID-19 Patients at a Tertiary Care Hospital in Pakistan

The Frequency of Neurological Symptoms in COVID-19 Patients at a Tertiary Care Hospital in Pakistan

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

Peripheral Neuropathy as a Complication of SARS-Cov-2

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