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Neurological Manifestations of COVID-19

August 13, 2020

Written by Clay Smith

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COVID-19 may cause a number of neurological manifestations. Here is what you need to know.

Why does this matter?
Neurological symptoms occurred in patients with SARS and MERS, but this was in <1%. SARS-CoV-2 appears to have not gotten the memo. Up to 7% of hospitalized patients and 69% of ICU patients with COVID-19 develop encephalopathy; 2-6% of hospitalized patients may have a stroke. COVID-19 can cause direct infection of the brain or inflammation related to the immune response, which may cause nervous system or vascular injury. What are the neurological changes you might see with COVID-19?

That virus went straight to my head
Here is a list of common neurological manifestations of COVID-19.

  • Acute loss of smell or taste (anosmia or ageusia)

  • Encephalopathy with altered mental status or seizure

  • Neuropsychiatric – psychosis, dementia-like, or affective

  • Stroke from hypercoagulability; possibly intracerebral hemorrhage, cerebral venous sinus thrombosis

  • CNS vasculitis or myelitis

  • Encephalitis or meningitis

  • Acute disseminated encephalomyelitis, Guillain-BarrĂ© syndrome, other acute neuropathies

  • Rhabdomyolysis

As a final important point, some COVID-19 infections have minimal respiratory symptoms and may present with neurological symptoms. It is best to wear PPE when working up a patient with acute, unexplained neurological symptoms and to test them for SARS-CoV-2.

Neurological associations of COVID-19. Lancet Neurol. 2020 Jul 2. pii: S1474-4422(20)30221-0. doi: 10.1016/S1474-4422(20)30221-0. [Epub ahead of print]

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