Abstract
BackgroundCOVID-19 is a pandemic disease and questions rise about the coronavirus 2 (Sars-CoV-2) effect on nervous system. This involvement could help explaining the pathogenesis of this condition and lead to novel therapeutic approaches.ObjectiveTo assess the occurrence of neurological symptoms in COVID-19 patients during the Italian pandemic outbreak, as reported by physicians.Materials and methodsIn the early days of pandemic emergence we developed an online survey open to all Italian clinicians involved in the diagnosis and management of COVID-19 patients. The survey was structured in three sections, with nine different items concerning the presence of different specific clinical abnormalities. Each item was graded from “absent” to “severe” in a 4-point Likert’s scale.Main outcomes and measuresLikert’s scale data were analyzed by studying the distribution of responses by using medians and bar charts-relative frequencies. Also, in order to analyze differences in symptoms findings depending on the group of specialty, Likert’s scale data were combined into two nominal categories (“absent”/“low” and “moderate”/”high”/”) and a contingency table chi-square test was used.Results126 physicians of 9 different medical specialties, from 10 regions of Italy, filled the online survey. The results show that 87.3% of practitioners reported neurological symptoms. In most cases these were mild and non-specific, but they were severe in a minority of patients. The most common symptoms observed were headache, myalgia and taste and smell abnormalities. Whilst there was no difference between neurologists and non-neurologists, we found that experienced clinicians (defined as clinicians that evaluated more than 30 patients) reported neurological symptoms more frequently than non-expert.ConclusionsNeurological symptoms have frequently been ported during the Italian COVID-19 pandemic, and thus should be monitored for all affected patients. Whilst some of the disturbances reported may be non-specific and common to other infectious diseases, smell and taste abnormalities might indicate nervous system as entry door for SARS-CoV-2 virus. This interpretation should promote research trials to avoid nervous system involvement.
Highlights
In March 2020 Italy became the second most affected country in the world and death toll overtook those in China
The results show that 87.3% of practitioners reported neurological symptoms
Whilst there was no difference between neurologists and non-neurologists, we found that experienced clinicians reported neurological symptoms more frequently than non-expert
Summary
Symptoms of COVID-19 include respiratory illness, fever, dry cough and dyspnea [1, 2]. There is a growing evidence that SARS-CoV-2 can involve organs other than the lung, including the nervous system [3, 4]. Other common symptoms include stroke, impairment of consciousness, seizure, and encephalopathy [8,9,10]. Some authors suggested that SARS-CoV-2 neurotropism could contribute to the severity of respiratory failure [11, 12]. COVID-19 is a pandemic disease and questions rise about the coronavirus 2 (Sars-CoV-2) effect on nervous system. This involvement could help explaining the pathogenesis of this condition and lead to novel therapeutic approaches
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