tetano
Editor, Senior Moderator
J Neurol Sci
. 2020 Sep 3;418:117118.
doi: 10.1016/j.jns.2020.117118. Online ahead of print.
Neurology of COVID-19 in Singapore
Jasmine Shimin Koh[SUP] 1 [/SUP], Deidre Anne De Silva[SUP] 2 [/SUP], Amy May Lin Quek[SUP] 3 [/SUP], Hui Jin Chiew[SUP] 1 [/SUP], Tian Ming Tu[SUP] 4 [/SUP], Christopher Ying Hao Seet[SUP] 1 [/SUP], Rebecca Hui Min Hoe[SUP] 1 [/SUP], Monica Saini[SUP] 1 [/SUP], Andrew Che-Fai Hui[SUP] 5 [/SUP], Jasmyn Angon[SUP] 6 [/SUP], Justin Ruixin Ker[SUP] 7 [/SUP], Ming Hui Yong[SUP] 2 [/SUP], Yihui Goh[SUP] 3 [/SUP], Wai-Yung Yu[SUP] 8 [/SUP], Tchoyoson Choie Cheio Lim[SUP] 8 [/SUP], Benjamin Yong Qiang Tan[SUP] 3 [/SUP], Kay Wei Ping Ng[SUP] 3 [/SUP], Leonard Leong Litt Yeo[SUP] 3 [/SUP], Yu Zhi Pang[SUP] 9 [/SUP], Kumar M Prakash[SUP] 10 [/SUP], Aftab Ahmad[SUP] 5 [/SUP], Terrence Thomas[SUP] 11 [/SUP], David Chien Boon Lye[SUP] 12 [/SUP], Kevin Tan[SUP] 1 [/SUP], Thirugnanam Umapathi[SUP] 13 [/SUP]
Affiliations
Abstract
Purpose: To describe the spectrum of COVID-19 neurology in Singapore.
Method: We prospectively studied all microbiologically-confirmed COVID-19 patients in Singapore, who were referred for any neurological complaint within three months of COVID-19 onset. Neurological diagnoses and relationship to COVID-19 was made by consensus guided by contemporaneous literature, refined using recent case definitions.
Results: 47,572 patients (median age 34 years, 98% males) were diagnosed with COVID-19 in Singapore between 19 March to 19 July 2020. We identified 90 patients (median age 38, 98.9% males) with neurological disorders; 39 with varying certainty of relationship to COVID-19 categorised as: i) Central nervous system syndromes-4 acute disseminated encephalomyelitis (ADEM) and encephalitis, ii) Cerebrovascular disorders-19 acute ischaemic stroke and transient ischaemic attack (AIS/TIA), 4 cerebral venous thrombosis (CVT), 2 intracerebral haemorrhage, iii) Peripheral nervous system-7 mono/polyneuropathies, and a novel group, iv) Autonomic nervous system-4 limited dysautonomic syndromes. Fifty-one other patients had pre/co-existent neurological conditions unrelated to COVID-19. Encephalitis/ADEM is delayed, occurring in critical COVID-19, while CVT and dysautonomia occurred relatively early, and largely in mild infections. AIS/TIA was variable in onset, occurring in patients with differing COVID-19 severity; remarkably 63.2% were asymptomatic. CVT was more frequent than expected and occurred in mild/asymptomatic patients. There were no neurological complications in all 81 paediatric COVID-19 cases.
Conclusion: COVID-19 neurology has a wide spectrum of dysimmune-thrombotic disorders. We encountered relatively few neurological complications, probably because our outbreak involved largely young men with mild/asymptomatic COVID-19. It is also widely perceived that the pandemic did not unduly affect the Singapore healthcare system.
Keywords: COVID-19; Coronavirus; Neurological manifestations; Pandemic; SARS-CoV-2.
. 2020 Sep 3;418:117118.
doi: 10.1016/j.jns.2020.117118. Online ahead of print.
Neurology of COVID-19 in Singapore
Jasmine Shimin Koh[SUP] 1 [/SUP], Deidre Anne De Silva[SUP] 2 [/SUP], Amy May Lin Quek[SUP] 3 [/SUP], Hui Jin Chiew[SUP] 1 [/SUP], Tian Ming Tu[SUP] 4 [/SUP], Christopher Ying Hao Seet[SUP] 1 [/SUP], Rebecca Hui Min Hoe[SUP] 1 [/SUP], Monica Saini[SUP] 1 [/SUP], Andrew Che-Fai Hui[SUP] 5 [/SUP], Jasmyn Angon[SUP] 6 [/SUP], Justin Ruixin Ker[SUP] 7 [/SUP], Ming Hui Yong[SUP] 2 [/SUP], Yihui Goh[SUP] 3 [/SUP], Wai-Yung Yu[SUP] 8 [/SUP], Tchoyoson Choie Cheio Lim[SUP] 8 [/SUP], Benjamin Yong Qiang Tan[SUP] 3 [/SUP], Kay Wei Ping Ng[SUP] 3 [/SUP], Leonard Leong Litt Yeo[SUP] 3 [/SUP], Yu Zhi Pang[SUP] 9 [/SUP], Kumar M Prakash[SUP] 10 [/SUP], Aftab Ahmad[SUP] 5 [/SUP], Terrence Thomas[SUP] 11 [/SUP], David Chien Boon Lye[SUP] 12 [/SUP], Kevin Tan[SUP] 1 [/SUP], Thirugnanam Umapathi[SUP] 13 [/SUP]
Affiliations
- PMID: 32977228
- DOI: 10.1016/j.jns.2020.117118
Abstract
Purpose: To describe the spectrum of COVID-19 neurology in Singapore.
Method: We prospectively studied all microbiologically-confirmed COVID-19 patients in Singapore, who were referred for any neurological complaint within three months of COVID-19 onset. Neurological diagnoses and relationship to COVID-19 was made by consensus guided by contemporaneous literature, refined using recent case definitions.
Results: 47,572 patients (median age 34 years, 98% males) were diagnosed with COVID-19 in Singapore between 19 March to 19 July 2020. We identified 90 patients (median age 38, 98.9% males) with neurological disorders; 39 with varying certainty of relationship to COVID-19 categorised as: i) Central nervous system syndromes-4 acute disseminated encephalomyelitis (ADEM) and encephalitis, ii) Cerebrovascular disorders-19 acute ischaemic stroke and transient ischaemic attack (AIS/TIA), 4 cerebral venous thrombosis (CVT), 2 intracerebral haemorrhage, iii) Peripheral nervous system-7 mono/polyneuropathies, and a novel group, iv) Autonomic nervous system-4 limited dysautonomic syndromes. Fifty-one other patients had pre/co-existent neurological conditions unrelated to COVID-19. Encephalitis/ADEM is delayed, occurring in critical COVID-19, while CVT and dysautonomia occurred relatively early, and largely in mild infections. AIS/TIA was variable in onset, occurring in patients with differing COVID-19 severity; remarkably 63.2% were asymptomatic. CVT was more frequent than expected and occurred in mild/asymptomatic patients. There were no neurological complications in all 81 paediatric COVID-19 cases.
Conclusion: COVID-19 neurology has a wide spectrum of dysimmune-thrombotic disorders. We encountered relatively few neurological complications, probably because our outbreak involved largely young men with mild/asymptomatic COVID-19. It is also widely perceived that the pandemic did not unduly affect the Singapore healthcare system.
Keywords: COVID-19; Coronavirus; Neurological manifestations; Pandemic; SARS-CoV-2.