Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study

Abstract

OBJECTIVETo study the neurological manifestations of patients with coronavirus disease 2019 . DESIGN Retrospective case series SETTINGThree designated COVID-19 care hospitals PARTICIPANTSTwo hundred fourteen hospitalized patients with laboratory confirmed diagnosis of severe acute respiratory syndrome from coronavirus 2 (SARS-CoV-2) infection. Data were collected from 16 January 2020 to 19 February 2020. MAIN OUTCOME MEASURESClinical data were extracted from electronic medical records and reviewed by a trained team of physicians. Neurological symptoms fall into three categories: central nervous system (CNS) symptoms or diseases (headache, dizziness, impaired consciousness, ataxia, acute cerebrovascular disease, and epilepsy), peripheral nervous system (PNS) symptoms (hypogeusia, hyposmia, hypopsia, and neuralgia), and skeletal muscular symptoms. Data of all neurological symptoms were checked by two trained neurologists. RESULTSOf 214 patients studied, 88 (41.1%) were severe and 126 (58.9%) were non-severe patients. Compared with non-severe patients, severe patients were older (58.7 ± 15.0 years vs 48.9 ± 14.7 years), had more underlying disorders (42 [47.7%] vs 41 All rights reserved. No reuse allowed without permission. the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint (which was not peer-reviewed) is . https://doi.org/10.1101/2020.02.22.20026500 doi: medRxiv preprint [32.5%]), especially hypertension (32 [36.4%] vs 19 [15.1%]), and showed less typical symptoms such as fever (40 [45.5%] vs 92 [73%]) and cough (30 [34.1%] vs 77 [61.1%]). Seventy-eight (36.4%) patients had neurologic manifestations. More severe patients were likely to have neurologic symptoms (40 [45.5%] vs 38 [30.2%]), such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]) and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]).

Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence

“…There are already some evidences that COVID-19 can cause damage to tissues and organs other than the lung. In a study of 214 COVID-19 patients, 78 (36.4%) patients had neurological manifestations [32]. In addition, there is already evidence of ocular surface infection in patients with COVID-19, and SARS-CoV-2 RNA was detected in eye secretions of patient [33].…”

Nervous system involvement after infection with COVID-19 and other coronaviruses

“…It is therefore likely that anosmia and dysgeusia might be observed in patients with COVID-19 (Giacomelli et al, 2020;Ryan, 2020;Hopkins and Kumar, 2020). In fact, some even develop COVID-19-related symptoms only after showing neurologic symptoms (Mao et al, 2020). Recently, Beijing Ditan Hospital reported for the first time a case of viral encephalitis caused by the novel CoV attacking the CNS.…”

“…Patients with COVID-19 often suffer from severe hypoxia and viremia , which has the potential to cause toxic encephalopathy. Moreover, almost 40% of patients with COVID-19 develop headache, disturbed consciousness, and other brain dysfunction symptoms (Mao et al, 2020), and that an autopsy study reported that edema has been detected in brain tissue of COVID-19 patients . Collectively, these findings provide the evidence that COVID-19 could cause infectious toxic encephalopathy, although detailed studies are greatly required.…”

“…It was recently documented that, in addition to systemic and respiratory symptoms, 36.4% (78/214) of patients with COVID-19 develop neurological symptoms, including headache, disturbed consciousness, and paresthesia. Severely affected patients are more likely to develop neurological symptoms than patients who have mild or moderate disease (Mao et al, 2020). Additionally, autopsy reports have revealed brain tissue edema and partial neuronal degeneration in deceased patients .…”

Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms

“…The evidence of acute neuropsychiatric symptoms in COVID-19 cases is emerging. An initial report of 217 hospitalized patients in Wuhan, China, described neurologic manifestations in nearly half of those with severe infection (40 of 88), including cerebrovascular complications (e.g., stroke), encephalopathies, and muscle injuries (Mao et al, 2020). Interestingly, total blood lymphocyte counts were significantly lower in patients with CNS-associated (e.g.…”