Case series/case reports
The objective of this retrospective multicentre cohort study was to investigate new-onset neurological impairment associated with COVID-19.
The study was conducted between 18 January and 20 March 2020, and included people with confirmed COVID-19 from 56 hospitals in three Chinese regions. The authors enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new onset critical neurological events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. Events included impaired consciousness (n=25) or/and stroke (n=10). The risk of critical neurological events was associated with age above 60 years and a previous history of neurological conditions. Non-critical events were seen in fewer than 1% (7/917), including muscle cramps, unexplained headache, occipital neuralgia, tic and tremor. Brain CT in 28 people led to new findings in nine. Findings from lumbar puncture in three with suspected CNS infection, unexplained headache or severe occipital neuralgia were unremarkable. The authors concluded that people with COVID-19 aged over 60 and with neurological comorbidities were at higher risk of developing critical neurological impairments, mainly impaired consciousness and cerebrovascular accidents. Moreover, they underline that brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. However, evidence of direct acute insult of SARS-COV-2 to the CNS was lacking.