Butt Isabel, Ochoa-Ferraro Antonio, Dawson Charlotte, Madathil Shyam, Gautam Nandan, Sawlani Vijay, Geberhiwot Tarekegn
University of Southampton School of Medicine, Southampton, UK.
Department of Diabetes, Endocrinology and Metabolism, Queen Elizabeth Hospital, Birmingham, UK.
J Clin Neurol. 2021 Jul;17(3):363-367. doi: 10.3988/jcn.2021.17.3.363.
The respiratory manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been extensively documented. There is emerging evidence that coronavirus disease 2019 (COVID-19) has number of other presenting features which might not be related to the severity of the respiratory disease. We have previously described a case of hypoactive delirium as the first manifestation of COVID-19 without profound lung disease. Here we present five cases of elderly patients, without a prior history of dementia and had no overt COVID-19-related pneumonia, who presented with the acute onset of delirium as the primary manifestation of COVID-19.
This retrospective, single-center study performed a health informatics search to produce a list of patients who were admitted with acute confusion and tested positive for the SARS-CoV-2 virus between March 1 and June 30, 2020. The electronic medical admission notes were screened for all patients with confusion who tested positive for SARS-CoV-2. Patients with a history of dementia and a high risk of delirium were excluded, such as severe COVID-19-related pneumonia or any other infection, malignancy, drugs, or severe illness of any kind.
During the first wave of the COVID-19 pandemic our hospital experienced just over 3,000 SARS-CoV-2 positive patients, and 45 of them had documented confusion upon admission. Secondary causes for their acute confusion were excluded. Five patients were identified as having delirium as the initial presentation of COVID-19-related illness without significant COVID-19-related pneumonitis. None of them had overt chest symptoms or a previous history of confusion, and the 3 patients who underwent head CT scans had normal findings.
This case series illustrates the importance of recognizing acute confusion as the first manifestation of COVID-19 in susceptible individuals.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的呼吸道表现已有大量文献记载。越来越多的证据表明，2019冠状病毒病（COVID-19）有许多其他表现特征，可能与呼吸道疾病的严重程度无关。我们之前曾描述过一例以活动减退性谵妄为COVID-19首发表现且无严重肺部疾病的病例。在此，我们报告5例老年患者，他们既往无痴呆病史，也没有明显的COVID-19相关肺炎，却以谵妄急性起病作为COVID-19的主要表现。
这项回顾性单中心研究通过健康信息学检索，列出了2020年3月1日至6月30日期间因急性意识模糊入院且SARS-CoV-2病毒检测呈阳性的患者名单。对所有意识模糊且SARS-CoV-2检测呈阳性的患者的电子医疗入院记录进行筛查。排除有痴呆病史和谵妄高风险的患者，如严重的COVID-19相关肺炎或任何其他感染、恶性肿瘤、药物或任何严重疾病。
在COVID-19大流行的第一波期间，我院有超过3000例SARS-CoV-2阳性患者，其中45例入院时有记录的意识模糊。排除了他们急性意识模糊的继发原因。5例患者被确定以谵妄作为COVID-19相关疾病的初始表现，且无明显的COVID-19相关肺炎。他们均无明显的胸部症状或既往意识模糊病史，3例接受头部CT扫描的患者结果正常。
该病例系列说明了认识到急性意识模糊是易感个体中COVID-19首发表现的重要性。
