Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea

Background and PurposeTo investigate the incidence and characteristics of neurological manifestations associated with coronavirus disease 2019 (COVID-19).MethodsWe reviewed the medical records of the consecutive patients with COVID-19 who were admitted to the central infectious diseases hospital designated for the treatment of COVID-19 in South Korea between March 2020 and September 2020. Newly developed neurological manifestations associated with COVID-19 were investigated. The frequency and clinical features of the neurological manifestations were analyzed according to disease severity, which was classified according to World Health Organization interim guidance.ResultsOf the 306 symptomatic patients, 186 (60.8%) developed at least one neurological manifestation during hospitalization. The most common neurological symptom was headache (n=102, 33.3%), followed by myalgia (n=96, 31.4%) and anosmia/ageusia (n=54, 17.6%). Acute stroke (all ischemic stroke) occurred in three (1.0%) patients, and new-onset seizures occurred in two (0.7%). Neurological manifestation was a presenting symptom of COVID-19 in 72 (23.5%) patients, and was the only symptom of COVID-19 in 12 (3.9%). Stroke, seizure, and impaired consciousness were significantly associated with severe to critical COVID-19, whereas headache and anosmia/ageusia were frequently found in patients with mild to moderate disease.ConclusionsNeurological manifestations were commonly observed in patients with COVID-19. During the current pandemic, when patients present with new-onset neurological symptoms, COVID-19 may be considered as part of the differential diagnosis. Attention to severe neurological complications is needed, especially in patients with severe or critical COVID-19.