By Antonella Macerollo
For November 2020, we have selected: Agarwal P. et al. Neurological manifestations in 404 COVID‑19 patients in Washington State. J Neurol 2020 Aug 6;1-3. doi: 10.1007/s00415-020-10087-z. Online ahead of print.
Since the beginning of the current COVID-19 pandemia, many neurologists and researchers started to investigate if this virus might cause neurological features similarly to other virus.
The COVID-19 paper of the month November describes neurological signs and symptoms of 404 consecutive patients with COVID-19 seen in outpatient clinics and hospitalized between February 20, 2020 and May 4, 2020 at Evergreen Hospital, Kirkland, Washington, USA. It is important to notice that this hospital was among the first to report cases and deaths of COVID-19 patients in the United States, indicating a high case load with COVID-19 patients.
The inclusion criteria were laboratory confirmed SARS-CoV-2 infection and new onset neurological manifestations confirmed via chart review by a neurologist and neuropsychologist.
The study reported 73.0% patients in total with neurological symptoms. Authors found that female and Asian patients were more likely to have neurological features of COVID-19 infection but these data did not reach statistical significance.
Among the patients with neurological features, 51.5% patients presented with the following Central Nervous System symptoms: altered mental status (21.3%), headache (20.3%) and dizziness (37.7%). Of note, 57% of patients with altered metal status had pre-existing dementia.
Additionally, 40.3% presented with Peripheral Nervous System symptoms, such as myalgia (32.4%) or impairment of taste (6.7%) and smell (4.5%).
24.5% patients of this cohort had acute neurological manifestations including altered mental status seen (21.3%), critical illness myopathy (2.0%), stroke including hemorrhagic stroke (0.7%) and seizures (0.5%). Six patients had multiple acute neurological manifestations. Overall, this COVID-19 paper of the month highlights that neurological symptoms related to COVID-19 mirror common symptoms seen in outpatient clinics. Clinicians need to be aware of COVID-19 to initiate early intervention and prevent community spread. Further studies are mandatory to investigate if this virus might cause long-term neurological sequalae.