Early neurological manifestations of hospitalized COVID-19 patients

Abstract

Introduction Neurological manifestations can occur during coronavirus disease 19 (COVID-19). Several pathogenic mechanisms have been hypothesized, without conclusive results. In this study, we evaluated the most frequent neurological symptoms in a cohort of hospitalized COVID-19 patients, and also investigated the possible relationship between plasmatic inflammatory indices and olfactory disorders (ODs) and between muscle pain and creatine kinase (CK). Methods We consecutively enrolled hospitalized COVID-19 patients. A structured questionnaire concerning typical and neurological symptoms, focusing on headache, dizziness, ODs, taste disorders (TDs), and muscle pain, was administrated by telephone interviews. Results Common neurological symptoms were reported in the early phase of the disease, with a median onset ranging from 1 to 3 days. Headache showed tension-type features and was more frequently associated with a history of headache. Patients with ODs less frequently needed oxygen therapy. Inflammatory indices did not significantly differ between patients with and without ODs. Muscle pain did not show any association with CK level but was more frequently associated with arthralgia and headache. Conclusion In our cohort, ODs were an early symptom of COVID-19, more frequently reported by patients with milder forms of disease. Headache in association with arthralgia and muscle pain seems to reflect the common symptoms of the flu-like syndrome, and not COVID-19 infection-specific.

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

“…(Table 3) The severity of headache was reported to be moderate to severe. Headaches were reported to have tension-type quality, [69] pain was reported to be bilateral with exacerbation by bending over, and mostly located in the temporo-parietal region or sometimes more anteriorly toward the forehead. [38] In most of these patients, headaches occurrence was associated with a past medical history of headaches.…”

“…[38] In most of these patients, headaches occurrence was associated with a past medical history of headaches. [69] Several potential underlying pathophysiological mechanisms were suggested, particularly for headaches in the forehead and periorbital regions [38]; notably, it could be due to a direct invasion of SARS-CoV-2 to the trigeminal nerve endings in the nasal cavity. The other proposed underlying mechanism is trigemino-vascular activation due to involvement of the endothelial cells of the vessel walls with high expression of angiotensin-converting enzyme 2 (ACE2).…”

“…As of now, five patients with ADEM have been reported after CoV infection; one adolescent with HCoV- [41], [42], [43], [44], [45], [46], [47], [48], [49],. [50], [51], [52], [53], [54], [55], 56), [57], [58], [ [43], [47], [48], [57], [60], [62], [69], [70], [71], [72] 173 NR in all articles. Kong Z et al [72]reported a 53 Y/O F with dizziness as the first presentation of COVID-19.…”

Regional and chronological differences in prevalences of olfactory and gustatory dysfunction in coronavirus disease (COVID-19): a systemic review and meta-analysis

“…Ten studies used history taking of olfactory and/or gustatory evaluation, 31 used selfreported surveys, six used a validated survey, and eight used validated instruments. Patients were diagnosed as COVID-19 by real-time polymerase chain reaction (RT-PCR) in most studies, except four 6,20,46,48 that did not report the testing tool. Table S1 Online.…”

Neurological reasons for consultation and hospitalization during the COVID-19 pandemic

“…Neurological disturbances are an increasingly recognized part of the clinical spectrum of COVID-19 [1][2][3][4][5][6][7][8][9][10][11]. This has represented a diagnostic and therapeutic challenge for the attending neurologist, particularly if one considers the difficulties in performing routine ancillary examinations in these patients in isolation with such a contagious condition.…”