Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. A total of 36.4% of the total sample of patients with SARS-CoV-2 infection demonstrated neurological manifestations of infection, with significantly greater likelihood found among those with severe infections.

Evidence Rating Level: 2 (Good)

While coronaviruses (CoVs) are known to impact the respiratory system they have systemic effects and can affect the central nervous system (CNS). This retrospective, observational case series aimed to study the neurological effects of SARS-CoV-2 through electronic medical records across three special care centers in Wuhan, China. These data were then separated into the following manifestation categories: 1) CNS (seizure, ataxia, headache, dizziness, impaired consciousness, cerebrovascular disease), 2) peripheral nervous system (anosmia, vision impairment, neuralgia), and 3) skeletal muscular injury. Of the 214 patients with COVID-19 (mean [SD] age = 52.7 [15.5] years, 59.3% female), 36.4% had neurological manifestations of the infection. Patients with more severe infection had greater neurologic manifestations compared to those with nonsevere infection (difference 15.3%, p = 0.02), including skeletal muscle injury (difference 14.5%, p<0.001), impaired consciousness (difference 12.4%, p<0.001), and acute cerebrovascular diseases (difference 4.9%, p = 0.03). No differences among the nonsevere groups with and without neurologic manifestations were discovered in laboratory findings. However, in the severe group, CNS manifestations were associated with lower lymphocyte levels and platelet counts, as well as higher blood urea nitrogen levels (median lymphocyte count 0.7 x 109/L [ range 0.1 to 1.6] vs 0.9 x 109/L [range 0.2 to 2.6], p = 0.007; median platelet count: 169.0 x 109/l [range 18.0 to 564.0] vs 220.0 x 109/L [range 109.0 to 576.0, p = 0.04; median blood urea nitrogen 5.00 mmol/L [range 2.3 to 48.1] vs 4.4 mmol/L [range 1.5 to 19.1], p = 0.04). This first empirical report of neurological manifestations in patients with COVID-19 strongly suggests that SARS-CoV-2 has the ability to impact more than the respiratory system. This will prove important in screening individuals who may not necessarily present with respiratory illness and in ongoing research related to brain health and functioning.

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