Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
JAMA Neurol. 2020 Jun 1;77(6):683-690. doi: 10.1001/jamaneurol.2020.1127.
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.
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.
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.
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%]).
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.
中国武汉的 2019 年冠状病毒病（COVID-19）疫情严重，有可能在全球范围内蔓延。一些研究描述了包括发热、咳嗽、腹泻和乏力在内的典型临床表现。然而，据我们所知，尚未有报道称 COVID-19 患者有任何神经表现。
研究 COVID-19 患者的神经表现。
设计、地点和参与者：这是一项回顾性、观察性病例系列研究。数据于 2020 年 1 月 16 日至 2020 年 2 月 19 日期间从华中科技大学附属协和医院的三个 COVID-19 特殊护理中心（主区、西区和肿瘤中心）收集，共纳入 214 例经实验室确诊的严重急性呼吸综合征冠状病毒 2 感染住院患者。
从电子病历中提取临床数据，由两名经过培训的神经科医生对所有神经症状数据进行检查。神经表现分为 3 类：中枢神经系统表现（头晕、头痛、意识障碍、急性脑血管病、共济失调和癫痫发作）、周围神经系统表现（味觉障碍、嗅觉障碍、视力障碍和神经痛）和骨骼肌损伤表现。
在 214 例 COVID-19 患者中（平均[标准差]年龄为 52.7[15.5]岁，87 例男性[40.7%]），根据呼吸状况，126 例（58.9%）患者为非重症感染，88 例（41.1%）为重症感染。总体而言，78 例（36.4%）患者有神经表现。与非重症感染患者相比，重症感染患者年龄更大，合并基础疾病的比例更高，特别是高血压，且 COVID-19 的典型症状（如发热和咳嗽）更少。感染更严重的患者有神经表现，如急性脑血管病（5[5.7%]例比 1[0.8%]例）、意识障碍（13[14.8%]例比 3[2.4%]例）和骨骼肌损伤（17[19.3%]例比 6[4.8%]例）。
COVID-19 患者通常有神经表现。在 COVID-19 流行期间，当遇到有神经表现的患者时，临床医生应怀疑严重急性呼吸综合征冠状病毒 2 感染为鉴别诊断，以避免延误诊断或误诊，从而错失治疗和预防进一步传播的机会。
