Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A Retrospective Case Series Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) from Wuhan China is serious and has the potential to become epidemic unfortunately worldwide. We aimed to describe the neurological manifestations of patients with COVID-19. Methods: In this retrospective, observational study, we enrolled two hundred fourteen hospitalized patients with laboratory confirmed diagnosis of severe acute respiratory syndrome from coronavirus 2 (SARS-CoV-2) infection in three designated COVID-19 care hospitals of the Union Hospitals of Huazhong University of Science and Technology in Wuhan, China. Data were collected from 16 January 2020 to 19 February 2020. Neurological symptoms fall into three categories: central nervous system (CNS) symptoms or diseases (headache, dizziness, impaired consciousness, ataxia, acute cerebrovascular disease, and epilepsy), peripheral nervous system (PNS) symptoms (hypogeusia, hyposmia, hypopsia, and neuralgia), and skeletal muscle injury. Data of all neurological symptoms were checked by two trained neurologists. Findings: Of 214 patients studied, 88 (41.1%) were severe and 126 (58.9%) were non-severe patients. Compared with non-severe patients, severe patients were older (58.7 ± 15.0 years vs 48.9 ± 14.7 years), had more underlying disorders (42 [47.7%] vs 41 [32.5%]), especially hypertension (32 [36.4%] vs 19 [15.1%]), and showed less typical symptoms such as fever (40 [45.5%] vs 92 [73%]) and cough (30 [34.1%] vs 77 [61.1%]). Seventy-eight (36.4%) patients had neurologic manifestations. More severe patients were likely to have neurologic symptoms (40 [45.5%] vs 38 [30.2%]), 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%]). Interpretation: Compared with non-severe patients with COVID-19, severe patients commonly had neurologic symptoms manifested as acute cerebrovascular diseases, impaired consciousness and skeletal muscle injury. Funding Statement: The authors stated: "None." Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Ethics Committee of Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Verbal consent was obtained from patients before the enrollment.