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Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

Our take —

SARS-CoV-2 infection may result in neurological complications (with or without typical symptoms), including impaired consciousness, muscle injury, and acute cerebrovascular events, which may lead to delayed or misdiagnosis and can also increase the risk of rapid clinical deterioration and mortality. Results of this study may not be generalizable to individuals with less severe disease. Analyses were not adjusted for potential confounders, and should be interpreted with caution. Larger studies with longitudinal assessment of medically-confirmed neurologic manifestations are warranted.

Study design

Case series, Retrospective cohort

Study population and setting

The study included 214 patients with laboratory-confirmed SARS-CoV-2 infection who presented to 3 special care centers for COVID-19 In Wuhan, China between January 16 to February 19, 2020. Categories of neurological manifestations examined related to the following three domains: the central nervous system, the peripheral nervous system, and skeletal muscular injury.

Summary of Main Findings

The mean age of the study participants was 52.7 years, and 40.7% were male. Patients were classified by severity of infection: non-severe (58.9%) and severe (41.1%). Overall, 36.4% of the 214 patients had neurologic manifestations. Patients with severe infection were more likely to experience neurological complications relative to those with non-severe infection (45.5% vs. 30.2%, respectively), including acute cerebrovascular disease (5.7% vs. 0.8%, respectively), impaired consciousness (14.8% vs. 2.4%), and skeletal muscle injury (19.3% vs. 4.8%). Most neurologic manifestations occurred a median of 1-2 days before hospital admission, and some patients presented with neurological manifestations without typical COVID-19 symptoms. Authors also characterized a broad array of laboratory findings regarding inflammatory responses and blood coagulation between patients with and without severe infection, and between those with and without all types of neurological manifestations.

Study Strengths

The study includes a broad characterization of laboratory measurements of inflammatory responses and blood coagulation among those with and without neurologic symptoms. Two trained neurologists reviewed and confirmed all neurological symptoms.

Limitations

The relatively small sample size from a select catchment area may limit generalizability. Data were obtained solely from electronic medical record review, which may result in bias if those with less severe neurological complications are not captured. Neurologic symptoms were based primarily on patients’ subjective experiences and were not confirmed by neuroimaging or other diagnostic procedures. Given the descriptive nature of the study, no formal hypotheses were tested, nor were analyses adjusted for any potential confounders.

Value added

This is one of the first known studies to examine the occurrence of COVID-19-associated neurological complications, even in the absence of respiratory symptoms.