Infectious Disease

Anosmia, myalgia, headache The most common neurological symptoms of COVID-19

March 12, 2021

2 min read

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Neurologic symptoms were among the most common clinical manifestations of COVID-19, with anosmia, myalgia, and headache being the most commonly reported, data shows.

David Garcia-Azorine, PhD, A neurologist and researcher at the Hospital Clínico Universitario de Valladolid and colleagues wrote in Brain and Behavior that only fever, cough, shortness of breath and asthenia are more common than neurological symptoms.

Reference: García-Azorín D, et al. Brain behavior 2021; doi: 10.1002 / brb3.2058.

The researchers conducted a retrospective cohort study of 576 adults (43.3% women; mean age 67.2 years) with confirmed COVID-19 who presented with 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%), dizziness (1.9%), ataxia (1%), and seizures (0.5%). Of all patients with neurological symptoms, 54.2% said symptoms started on the same day as their other COVID-19 symptoms.

García-Azorín and colleagues also found that patients with neurological symptoms who appeared later than those without these symptoms on ED (7.9 vs. 6.6 days; P = 0.19) and tended to be younger had better Baseline performance and fewer prior heart conditions. In addition, 0.6% of COVID-19 cases with neurological symptoms showed no “typical” COVID-19 symptoms, and 1.9% had “completely normal laboratory parameters,” the researchers wrote. In patients 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 results of this study was the impact of neurological symptoms on patient prognosis,” wrote García-Azorín and colleagues. “We analyzed the relationship between the presence of neurological symptoms at presentation and after adjusting for age, gender, output performance, time since symptoms appeared, vascular risk factors, comorbidities and general symptoms, anosmia and altered psychological status were still associated with a lower or higher level of mental health. higher death rate. ”

They added that some comorbidities, such as heart disease and diabetes, were only associated with poorer prognosis in univariate models.

“The large number of parameters analyzed could reduce the validity of the study and some variables could be false negatives,” wrote García-Azorín and colleagues. “The exact meaning of each symptom should probably be analyzed separately.”

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Jeremy Payne, MD, PhD)

Jeremy Payne, MD, PhD

García-Azorín and colleagues’ findings on neurological symptoms of COVID-19 in Spain are fully in line with those observed by ED doctors in the US during the pandemic. Most of the common neurological symptoms discussed by these researchers, such as headache, fatigue, and muscle pain, can occur with many other diseases. Even so, it is tempting to wonder if the persistent headaches some patients with COVID-19 report may be similarly related to something specific in the brain. The sudden loss of smell appears to be a consistent predictor of COVID-19 infection, and while this symptom says something about the mechanism of the infection, it remains poorly understood.

It’s worth noting that extensive research into what some neurologists consider to be harsh neurological symptoms and side effects of COVID-19 like stroke is elusive. Some of us in the neurological community have had so many strokes in the past year that we were able to predict the COVID-19 status of some patients based on the appearance of their brain imaging and clinical history. However, we still do not understand enough the link between stroke and COVID-19 to fully warrant prescribing anticoagulants, the only specific stroke prevention strategy we currently have for these patients. It would be helpful to know if there is anything else we should do for them. An investigation into why some patients with COVID-19 have persistent brain fog, confusion, and / or headache weeks after being determined to be free and disease free would also be helpful.

Jeremy Payne, MD, PhD

Neurologist, Banner Health, Phoenix

Disclosure: Payne does not report any relevant financial information.

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