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Neurological symptoms in acute COVID-19 infected patients: A survey among Italian physicians.

ABSTRACT: BACKGROUND:COVID-19 is a pandemic disease and questions rise about the coronavirus 2 (Sars-CoV-2) effect on nervous system. This involvement could help explaining the pathogenesis of this condition and lead to novel therapeutic approaches. OBJECTIVE:To assess the occurrence of neurological symptoms in COVID-19 patients during the Italian pandemic outbreak, as reported by physicians. MATERIALS AND METHODS:In the early days of pandemic emergence we developed an online survey open to all Italian clinicians involved in the diagnosis and management of COVID-19 patients. The survey was structured in three sections, with nine different items concerning the presence of different specific clinical abnormalities. Each item was graded from "absent" to "severe" in a 4-point Likert's scale. MAIN OUTCOMES AND MEASURES:Likert's scale data were analyzed by studying the distribution of responses by using medians and bar charts-relative frequencies. Also, in order to analyze differences in symptoms findings depending on the group of specialty, Likert's scale data were combined into two nominal categories ("absent"/"low" and "moderate"/"high"/") and a contingency table chi-square test was used. RESULTS:126 physicians of 9 different medical specialties, from 10 regions of Italy, filled the online survey. The results show that 87.3% of practitioners reported neurological symptoms. In most cases these were mild and non-specific, but they were severe in a minority of patients. The most common symptoms observed were headache, myalgia and taste and smell abnormalities. Whilst there was no difference between neurologists and non-neurologists, we found that experienced clinicians (defined as clinicians that evaluated more than 30 patients) reported neurological symptoms more frequently than non-expert. CONCLUSIONS:Neurological symptoms have frequently been ported during the Italian COVID-19 pandemic, and thus should be monitored for all affected patients. Whilst some of the disturbances reported may be non-specific and common to other infectious diseases, smell and taste abnormalities might indicate nervous system as entry door for SARS-CoV-2 virus. This interpretation should promote research trials to avoid nervous system involvement.

SUBMITTER: Campiglio L

PROVIDER: S-EPMC7489055 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Neurological symptoms in acute COVID-19 infected patients: A survey among Italian physicians.

Campiglio Laura L Priori Alberto A

PloS one 20200911 9

<h4>Background</h4>COVID-19 is a pandemic disease and questions rise about the coronavirus 2 (Sars-CoV-2) effect on nervous system. This involvement could help explaining the pathogenesis of this condition and lead to novel therapeutic approaches.<h4>Objective</h4>To assess the occurrence of neurological symptoms in COVID-19 patients during the Italian pandemic outbreak, as reported by physicians.<h4>Materials and methods</h4>In the early days of pandemic emergence we developed an online survey ...[more]

PMID: 32915818

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Project description:Background and purposeDuring acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry.MethodsWe analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression.ResultsA total of 6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20-1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07-1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19.ConclusionOur data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.

Project description:BackgroundGrowing evidence suggests that the central nervous system is affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), since infected patients suffer from acute and long-term neurological sequelae. Nevertheless, it is currently unknown whether the virus affects the brain cortex. The purpose of this study was to assess the cortical gray matter volume, the cortical thickness, and the cortical surface area in a group of SARS-CoV-2 infected patients with neurological symptoms compared to healthy control subjects. Additionally, we analyzed the cortical features and the association with inflammatory biomarkers in the cerebrospinal fluid (CSF) and plasma.Materials and methodsThirty-three patients were selected from a prospective cross-sectional study cohort during the ongoing pandemic (August 2020-April 2021) at the university hospitals of Basel and Zurich (Switzerland). The group included patients with different neurological symptom severity (Class I: nearly asymptomatic/mild symptoms, II: moderate symptoms, III: severe symptoms). Thirty-three healthy age and sex-matched subjects that underwent the same MRI protocol served as controls. For each anatomical T1w MPRAGE image, regional cortical gray matter volume, thickness, and surface area were computed with FreeSurfer. Using a linear regression model, cortical measures were compared between groups (patients vs. controls; Class I vs. II-III), with age, sex, MRI magnetic field strength, and total intracranial volume/mean thickness/total surface area as covariates. In a subgroup of patients, the association between cortical features and clinical parameters was assessed using partial correlation adjusting for the same covariates. P-values were corrected using a false discovery rate (FDR).ResultsOur findings revealed a lower cortical volume in COVID-19 patients' orbitofrontal, frontal, and cingulate regions than in controls (p < 0.05). Regional gray matter volume and thickness decreases were negatively associated with CSF total protein levels, the CSF/blood-albumin ratio, and CSF EN-RAGE levels.ConclusionOur data suggest that viral-triggered inflammation leads to neurotoxic damage in some cortical areas during the acute phase of a COVID-19 infection in patients with neurological symptoms.

Dataset Information

Neurological symptoms in acute COVID-19 infected patients: A survey among Italian physicians.

Publications

Neurological symptoms in acute COVID-19 infected patients: A survey among Italian physicians.

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