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Observational Study
. 2020 Jun 1;77(6):683-690.
doi: 10.1001/jamaneurol.2020.1127.

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

Ling Mao  1 , Huijuan Jin  1 , Mengdie Wang  1 , Yu Hu  2 , Shengcai Chen  1 , Quanwei He  1 , Jiang Chang  3 , Candong Hong  1 , Yifan Zhou  1 , David Wang  4 , Xiaoping Miao  3 , Yanan Li  1 , Bo Hu  1
Affiliations
Observational Study

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

Ling Mao et al. JAMA Neurol. .

Abstract

Importance: The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations.

Objective: To study the neurologic manifestations of patients with COVID-19.

Design, setting, and participants: This is a retrospective, observational case series. Data were collected from January 16, 2020, to February 19, 2020, at 3 designated special care centers for COVID-19 (Main District, West Branch, and Tumor Center) of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China. The study included 214 consecutive hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection.

Main outcomes and measures: Clinical data were extracted from electronic medical records, and data of all neurologic symptoms were checked by 2 trained neurologists. Neurologic manifestations fell into 3 categories: central nervous system manifestations (dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure), peripheral nervous system manifestations (taste impairment, smell impairment, vision impairment, and nerve pain), and skeletal muscular injury manifestations.

Results: Of 214 patients (mean [SD] age, 52.7 [15.5] years; 87 men [40.7%]) with COVID-19, 126 patients (58.9%) had nonsevere infection and 88 patients (41.1%) had severe infection according to their respiratory status. Overall, 78 patients (36.4%) had neurologic manifestations. Compared with patients with nonsevere infection, patients with severe infection were older, had more underlying disorders, especially hypertension, and showed fewer typical symptoms of COVID-19, such as fever and cough. Patients with more severe infection had neurologic manifestations, such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]), and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]).

Conclusions and relevance: Patients with COVID-19 commonly have neurologic manifestations. During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Representative Computed Tomography (CT) Images of a Patient With Coronavirus Disease 2019 With New Onset of Ischemic Stroke
A, Brain CT image 1 day after ischemic stroke. White arrowhead indicates the ischemic lesion. B, Chest CT image 1 day after ischemic stroke.
See this image and copyright information in PMC

Comment in

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    Vaira LA, Salzano G, Deiana G, De Riu G. Vaira LA, et al. Laryngoscope. 2020 Jul;130(7):1787. doi: 10.1002/lary.28692. Epub 2020 Apr 15. Laryngoscope. 2020. PMID: 32237238 Free PMC article.
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    Orozco-Hernández JP, Marin-Medina DS, Sánchez-Duque JA. Orozco-Hernández JP, et al. Semergen. 2020 Aug;46 Suppl 1:106-108. doi: 10.1016/j.semerg.2020.05.004. Epub 2020 May 11. Semergen. 2020. PMID: 32439269 Free PMC article. Spanish. No abstract available.
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