DOM COVID-19 Journal Club: Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China

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Purpose: Study the neurological manifestations of patients with COVID-19

Study design: Retrospective, observational study done at 3 centers in Wuhan, China analyzing lab-confirmed COVID-19 (+) patients. Data was extracted from the electronic medical record, EMR, of patients with neurological symptoms and assessed by 2 neurologists. Neurological manifestations were classified as central nervous system (CNS), peripheral nervous system (PNS) or skeletal muscle injury manifestation.

3 Categories of Neurological Manifestations:

  • Central Nervous System: dizziness, headache, impaired consciousness, acute cerebrovascular dx, ataxia and seizure
  • Peripheral Nervous System: taste, smell or vision impairment and nerve pain
  • Skeletal Muscular Injury Manifestations: skeletal muscle pain with elevated serum CK > 200U/L

Conclusion: Patients with severe infection were significantly older, more likely to have underlying disorders (especially hypertension), fewer typical symptoms of COVID-19 (like fever and dry cough) and nervous system manifestations were more common.

Limitation: Sample size (only 214 patients from 3 centers in Wuhan), all data extracted from EMR, clinical data not available at time of analysis (patients were still hospitalized) and advanced neuroimaging and diagnostic procedures were purposely avoided to reduce risk of cross infection.

Context: From the article, COVID-19 known to affect respiratory tract, skeletal muscle and nervous system with greater neurological involvement in those with severe infection. During this current pandemic, COVID-19 should be included in the differential diagnosis of any patient presenting with neurological symptoms to prevent a delay in diagnosis and isolation precautions.

Reference:

The Department of Medicine COVID-19 Journal Club is dedicated to understand and applying data on COVID-19 to inform prevention and management efforts for healthcare workers and patients

This article by Shenikqua Bouges, MD, advanced geriatrics fellow, Geriatrics and Gerontology. Reviewed by Nasia Safdar, MD, PhD, professor, Infectious Disease, vice chair for research, Department of Medicine.

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