The most common neurological symptoms of Covid-19 – and how 'red flags' can be identified earlier

  • A recent study analysed 725 hospitalised Covid-19 patients
  • Researchers carried out brain imaging in 108 of these patients
  • Results showed two specific, common neurological symptoms

According to a recent study by University of Cincinnati researchers and four Italian institutions, altered mental status and stroke are the most common neurological symptoms in Covid-19 patients. The research team, whose work was published in the journal Radiology, examined 725 hospitalised patients who presented with Covid-19, of whom 108 (15%) presented with serious neurological symptoms that required neuroimaging. 

Neuroimaging, also known as brain imaging, uses various methods to allow neuroscientists to see inside the living brain. Analysing neuroimaging, as well as neurological symptoms in patients with Covid-19 may provide insight on how SARS-CoV-2 (the virus that causes Covid-19) can impact the central nervous system.

Altered mental state and stroke

The majority of the 108 patients (99%) with confirmed Covid-19 underwent CT scans, while 16% received head and neck CT imaging, and 18% had a brain MRI. The most common neurological symptoms the team of 15 researchers found was 59% of patients reporting an “altered mental state”, and 31% experiencing stroke. Headache (12%), seizure (9%) and dizziness (4%) were also reported.

"Of these 108 patients, 31, or 29%, had no known past medical history. Of these, aged 16 to 62 years, 10 experienced stroke and two had brain bleeds," lead author Abdelkader Mahammedi, MD, assistant professor of radiology at UC and a UC Health neuroradiologist wrote, further explaining: "Seventy-one, or 66%, of these patients revealed nothing on a brain CT, while in seven of them (35%) brain MRI showed abnormalities."

Mahammedi also explained that there are studies that describe the spectrum of chest imaging features of Covid-19, while only a few existing cases report neurological symptoms. A study published in the American Journal of Roentgenology last month, for example, analysed chest CT findings in paediatric patients (10 months to 18 years) with lab-confirmed Covid-19. 

"To date, this is the largest and first study in the literature that characterises the neurological symptoms and neuroimaging features in Covid-19 patients. These newly discovered patterns could help doctors better and sooner recognise associations with Covid-19 and possibly provide earlier interventions," Mahammedi said.

The team also found that altered mental status was more common in older adults. Apart from the two common conditions found in Covid-19 patients during the study, Mahammedi also stressed that scientists continue to explore other symptoms that may be a red flag and help physicians spot the disease earlier.

"This topic definitely needs more research. Currently, we have a poor understanding of the neurological symptoms in Covid-19 patients, whether these are arising from critical illness or from direct central nervous system invasion of SARS-CoV-2. We hope further study on this subject will help in uncovering clues and providing better interventions for patients," he said.

As of 2 June, 6.2 million confirmed cases and over 375 000 deaths have been recorded globally by the Johns Hopkins Coronavirus Resource Centre.

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