Abstract
BackgroundsThe reports of neurological symptoms are increasing in cases with coronavirus disease 2019 (COVID-19). This multi-center prospective study was conducted to determine the incidence of neurological manifestations in hospitalized cases with COVID-19 and assess these symptoms as the predictors of severity and death.MethodsHospitalized males and females with COVID-19 who aged over 18 years were included in the study. They were examined by two neurologists at the time of admission. All survived cases were followed for 8 weeks after discharge and 16 weeks if their symptoms had no improvements.ResultsWe included 873 participants. Of eligible cases, 122 individuals (13.97%) died during hospitalization. The most common non-neurological manifestations were fever (81.1%), cough (76.1%), fatigue (36.1%), and shortness of breath (27.6%). Aging, male gender, co-morbidity, smoking, hemoptysis, chest tightness, and shortness of breath were associated with increased odds of severe cases and/or mortality. There were 561 (64.3%) cases with smell and taste dysfunctions (hyposmia: 58.6%; anosmia: 41.4%; dysguesia: 100%). They were more common among females (69.7%) and non-smokers (66.7%). Hyposmia/anosmia and dysgeusia were found to be associated with reduced odds of severe cases and mortality. Myalgia (24.8%), headaches (12.6%), and dizziness (11.9%) were other common neurological symptoms. Headaches had negative correlation with severity and death due to COVID-19 but myalgia and dizziness were not associated. The cerebrovascular events (n = 10) and status epilepticus (n = 1) were other neurological findings. The partial or full recovery of smell and taste dysfunctions was found in 95.2% after 8 weeks and 97.3% after 16 weeks. The parosmia (30.9%) and phantosmia (9.0%) were also reported during 8 weeks of follow-up. Five cases with mild headaches and 5 cases with myalgia were reported after 16 weeks of discharge. The demyelinating myelitis (n = 1) and Guillain-Barré syndrome (n = 1) were also found during follow-up.ConclusionNeurological symptoms were found to be prevalent among individuals with COVID-19 disease and should not be under-estimated during the current pandemic outbreak.
Highlights
The novel virus from the coronaviridae family termed as severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was first discovered in December, 2019 after many pneumonia cases with unknown cause were identified in Wuhan, China [1]
Males and females aged above 18 years who were diagnosed with COVID-19 based on World Health Organization (WHO) recommendations [17] were included in the study
Primary screening was performed on 1269 inpatients and 873 cases were included in the study (Fig. 1)
Summary
The novel virus from the coronaviridae family termed as severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was first discovered in December, 2019 after many pneumonia cases with unknown cause were identified in Wuhan, China [1]. Several non-respiratory symptoms have been reported in individuals with COVID-19. Recent studies showed that SARS-CoV-2 could manifest as life-threatening neurological conditions including ischemic stroke, subarachnoid hemorrhage, status epilepticus, and acute demyelinating encephalomyelitis [10,11,12,13]. Neurological symptoms were reported in epidemic outbreaks of other coronaviruses including SARS-CoV and the Middle East respiratory syndrome (MERS)-CoV [14, 15]. This study aimed to determine the incidence of neurological manifestations in hospitalized cases with COVID-19 and assess these symptoms as predictors of severity and death
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