Cross-sectional case-control studies (Blue)
The objective of this study was to characterise patients with COVID-19 who presented primarily with neurological symptoms without typical COVID-19 symptoms of fever, cough, and dyspnoea. The authors retrospectively identified COVID-19-positive patients 18 years and older that had neurological 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 data, clinical symptoms, laboratory results, and clinical outcomes were collected. Out of 282 patients who had a neurology consultation during this period, the authors identified 56 patients (mean age 69.2 years, 57% women) who tested COVID-19-positive and had neurological 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 neurological symptom, followed by stroke, unsteady gait, headache, seizure, syncopal event, acute visual 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. The authors concluded that patients who have COVID-19 can present with serious neurological symptoms, such as impaired consciousness and stroke, even without typical COVID-19 symptoms. People without typical COVID-19 symptoms can later develop typical symptoms severe enough to need respiratory support.