Neurological manifestations as primary presentation of COVID‐19 in hospitalized patients

Abstract

Objective To characterize patients with coronavirus disease 2019 (COVID‐19) who presented primarily with neurologic symptoms without typical COVID‐19 symptoms of fever, cough, and dyspnea. Methods We retrospectively identified COVID‐19‐positive patients 18 years and older that had neurology symptoms on presentation requiring neurology consultation between March 14, 2020 and May 18, 2020. The patients were then classified into those with typical COVID‐19 symptoms and those without. Demographic, clinical symptoms, laboratory result, and clinical outcomes were collected. Results Out of 282 patients who had neurology consult during this period, we identified 56 (mean age 69.2 years, 57% women) who tested COVID‐19‐positive and had neurologic symptoms on initial presentation. Of these, 23 patients (mean age 65.2 years, 52% women) had no typical COVID‐19 symptoms while 33 did (mean age 72.2 years, 60% woman). In both groups, impaired consciousness was the most common initial neurologic symptom, followed by stroke, unsteady gait, headache, seizure, syncopal event, acute vision changes, and intracranial hemorrhage. Out of the 23 patients without typical COVID‐19 symptoms on presentation, 10 went on to develop typical symptoms with 8 needing supplemental oxygen and one requiring mechanical ventilation. Conclusion Patients who have COVID‐19 can present with serious neurologic symptoms such as impaired consciousness and stroke even without typical COVID‐19 symptoms. Those without typical COVID‐19 symptoms can later develop typical symptoms severe enough to need respiratory support.

COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)

“…Current reports of neurological symptoms/signs and complications of this infection are limited due to the small number of included patients and relatively short duration of data collection which could hinder more precise estimates and detection of rarer manifestations (Amanat et al 2021;Benussi et al 2020;Chachkhiani et al 2020;Chuang et al 2021;Collantes et al 2021;Flores-Silva et al 2021). Although there were two powered studies that provided a glimpse on the effects of neurological manifestations on mortality (Eskandar et al 2021;Frontera et al 2021), there are no comparative cohort studies yet that explored the effects of new-onset neurological symptoms (NNS) on other clinically relevant outcomes such as respiratory failure, duration of ventilator dependence, admission to the intensive care (ICU) unit and length of ICU and hospital stay.…”

The association between SARS-CoV-2 infection and neuronal damage: A population-based nested case-control study

“…Neurological signs and symptoms are reported in more than one-third of coronavirus disease-19 (COVID-19) patients, sometimes even as the presenting or sole manifestation of the disease. 1,2 Although (para-)infectious neuronal injury has been demonstrated in hospitalized cases with severe to critical illness, [3][4][5][6][7][8][9] it is still unclear whether it also occurs in patients with mild-to-moderate disease in whom neurological symptoms are also very common. 1 Therefore, we assessed whether severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with changes in plasma levels of neurofilament light chain (NfL), an ultrasensitive marker of neuroaxonal damage, in community-dwelling individuals.…”

Brain and nerves affected before the lungs in COVID‐19

“…1 It was concluded that "patients with COVID-19 can present with serious neurologic symptoms such as impaired consciousness and stroke even without typical COVID-19 symptoms". 1 The study is appealing but raises the following comments and concerns.The authors mix up symptoms with diagnoses. The aim of the study was to "characterize patients with coronavirus disease 2019 (COVID-19) and present primarily with neurologic symptoms without typical COVID-19 symptoms".…”

“…1 It was concluded that "patients with COVID-19 can present with serious neurologic symptoms such as impaired consciousness and stroke even without typical COVID-19 symptoms". 1 The study is appealing but raises the following comments and concerns.…”

“…Interestingly, none of the included patients reported ageusia, hypogeusia, dysgeusia, anosmia, hyposmia, or dysosmia as initial neurological presentation of SARS-CoV-2 infection. 1 Ageusia/hypogeusia has been repeatedly reported as initial manifestations of a SARS-CoV-2 infection. 2,3 We should know whether the patients were actively asked for neurological symptoms or not.…”