Assessment of neurological manifestations in hospitalized patients with COVID‐19

Abstract

Background and purpose: The objective of this study was to assess the neurological manifestations in a series of consecutive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients, comparing their frequency with a population hospitalized in the same period for flu/respiratory symptoms, finally not related to SARS-CoV-2. Methods: Patients with flu/respiratory symptoms admitted to Fondazione Policlinico Gemelli hospital from 14 March 2020 to 20 April 2020 were retrospectively enrolled. The frequency of neurological manifestations of patients with SARS-CoV-2 infection was compared with a control group. Results: In all, 213 patients were found to be positive for SARS-CoV-2, after reverse transcriptase polymerase chain reaction on nasal or throat swabs, whilst 218 patients were found to be negative and were used as a control group. Regarding central nervous system manifestations, in SARS-CoV-2-positive patients a higher frequency of headache, hyposmia and encephalopathy always related to systemic conditions (fever or hypoxia) was observed. Furthermore, muscular involvement was more frequent in SARS-CoV-2 infection. Conclusions: Patients with COVID-19 commonly have neurological manifestations but only hyposmia and muscle involvement seem more frequent compared with other flu diseases.

Predicting In‐Hospital Mortality in COVID‐19 Older Patients with Specifically Developed Scores

“…Apart from qCSI that evaluate only respiratory distress, all the scores evaluate neurological status, by using a simplified version of GCS (normal or <15 for ISARIC‐4C), the Alert, Verbal, Pain, Unresponsive (AVPU) scale (for NEWS), and simply conscious/unconscious for COVID‐GRAM. However, although neurologic involvement is common in COVID‐19, a severe depression of consciousness is rare 21 . Indeed, in our cohort only seven (3.3%) patients presented with GCS less than 15 at admission, and three (1.4%) were unconscious.…”

Global prevalence and pathogenesis of headache in COVID-19: A systematic review and meta-analysis

“…In total, 78 studies were included to calculate the prevalence of headache in COVID-19 and all studies were published in 2020. The studies were conducted in Brazil 50 , China 13,51-96 , Egypt 97 , France 98-101 , Germany 102 , India 103,104 , Italy [105][106][107][108][109][110][111] , Japan 112,113 , Jordan 114 , Somalia 115 , South Korea 116,117 , Spain 118,119 , Turkey 120,121 , and the US [122][123][124][125][126] . Two studies were cross-sectional 119,122 , five were prospective cohort studies 65,90,98,110,121 and the remaining 71 studies were retrospective studies.…”

“…The rest of the references had been excluded for these reasons: (a) the studies were case reports or case-series (n=98); (b) the full-text did not include data of outcome of interest (n=84); and (c) low quality of study (n=3) ( Figure 1). The included studies were conducted in a wide ranges of regions: Australia 127 120 , and the US 28,105,122,132,133 . Out of the studies, ten were case-control 28,29,31,99,105,120,128,130,132 , four were cross-sectional 50,70,122,131,133 , and two were prospective cohort studies 127,129 .…”

“…A total of 16 studies, consisting of 5,407 COVID-19 cases in adults and 94,818 adults with non-COVID-19 infections (mostly COVID-19-like respiratory viral infections), were analyzed to determine the association between headache and COVID-19. Of these studies, an association between headache and the occurrence of COVID-19 was observed in 9 studies 28,29,31,105,122,127,129,130,132 while seven studies reported no association 50,70,99,120,131,133,134 ( Table 2). Our cumulative calculation revealed that headache was found to be 1.7-fold more prevalent in patients with COVID-19 compared to those with non-COVID-19 respiratory viral infections, OR: 1.73; 95% CI: 1.94, 2.51 with p=0.04.…”

Reassessing IVIg therapy in chronic inflammatory demyelinating polyradiculoneuropathy during COVID-19: a chance to verify the need for chronic maintenance therapy

“…Patients with COVID-19 frequently manifest neurological symptoms, including acute cerebrovascular diseases, consciousness impairment, and skeletal muscle injury. Peripheral nervous system (PNS) involvement is reported in patients with COVID-19, but it is still unknown if and how SARS-CoV-2 can affect it [ 4 ].…”