Anosmia, myalgia, headache most common neurological symptoms of COVID-19
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Neurological symptoms were among the most common clinical manifestations of COVID-19, with anosmia, myalgia and headache being the most frequently reported, data show.
David García-Azorín, PhD, a neurologist and researcher at Hospital Clínico Universitario de Valladolid, and colleagues wrote in Brain and Behavior that only fever, cough, dyspnea and asthenia were more common than neurological symptoms.
The researchers performed a retrospective cohort study of 576 adults (43.3% women; mean age, 67.2 years) with confirmed COVID-19 who presented to an ED in Spain between March 8, 2020, and April 11, 2020.
The researchers reported that 55.6% of the patients described neurological symptoms at the time of ED presentation. The most common neurological manifestation was anosmia (25.3%), followed by myalgia (24.1%), headache (23.8%) and altered mental status (17%). The four least common symptoms were “sudden” focal symptoms (2.1%), vertigo (1.9%) ataxia (1%) and seizures (0.5%). Among all those with neurological symptoms, 54.2% said the symptoms started the same day as their other COVID-19 symptoms.
García-Azorín and colleagues also found that patients with neurological symptoms presented to the ED later than those without these symptoms (7.9 vs. 6.6 days; P = .19) and tended to be younger, have better baseline performance and fewer previous cardiac disorders. Also, 0.6% of the COVID-19 cases with neurological symptoms did not show “typical” COVID-19 symptoms, and 1.9% had “fully normal laboratory parameters,” the researchers wrote. In those with neurological symptoms, the presence of other COVID-19 symptoms was associated with a sensitivity of 98.7% (95% CI, 96.6-99.6), and the presence of laboratory abnormalities had a sensitivity of 98.1% (95% CI: 95.7-99.2).
Further analysis showed that anosmia was an independent predictor of lower in-hospital mortality (HR = 0.358; 95% CI, 0.14-0.916), while altered mental status was associated with higher in-hospital mortality (HR =1.867, 95% CI, 1.162–3.001).
“One of the most striking findings of this study was the impact of the neurological symptoms in the prognosis of patients,” García-Azorín and colleagues wrote. “We analyzed the association between the presence of neurological symptoms on presentation, and after adjusting for age, sex, baseline performance, time since the symptoms onset, vascular risk factors, comorbidities, and general symptoms, anosmia and altered mental status were still associated with a lower and higher odd of mortality, respectively.”
They added that some comorbidities, such as cardiac disorders and diabetes, were only linked to a worse prognosis in univariate models.
“The high number of analyzed parameters could decrease the power of the study and some variables could be falsely negative,” García-Azorín and colleagues wrote. “The precise signification of each symptom should probably be analyzed separately.”
Perspective
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García-Azorín and colleagues’ findings regarding neurological symptoms of COVID-19 in Spain is wholly consistent with what United States ED doctors are seeing during the pandemic. Most of the general neurological symptoms these researchers discuss, like headache, fatigue and muscle ache, can occur with many other illnesses. That said, it is tantalizing to wonder if maybe the persistent headaches some patients with COVID-19 report are similarly related to something specific happening in the brain. The sudden loss of smell seems to be a consistent predictor of COVID-19 infection, and while that symptom suggests something about the mechanism of infection, it remains insufficiently understood.
It is worth noting that extensive research on what some neurologists consider hard neurological symptoms and side effects of COVID-19, such as stroke, remains elusive. Some of us in the neurological community have seen so many strokes in the past year that we have been able to predict the COVID-19 status of some patients based on the appearance of their brain imaging and clinical history. But we still do not understand the connection between strokes and COVID-19 enough to completely justify prescribing anticoagulants, the only specific stroke prevention strategy we currently have for these patients. It would be helpful to know if there is something else we should be doing for them. Research into why some patients with COVID-19 have a persistent brain fog, confusion and/or headache weeks after they have told they are free and clear of the disease would be helpful as well.
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