Background: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms. Methods: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms. Results: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days. Conclusion: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.


中文翻译：

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神经系统症状作为 Covid-19 的初始表现——一项观察性研究


背景：呼吸系统受累和发热被认为是 Covid-19 感染筛查病例检测的主要表现。我们（印度）进入 Covid-19 的第四个月，病例仍在上升，这可能意味着发烧和呼吸道症状可能不是唯一的初始症状。因此，我们打算调查神经系统症状是否可以先于主要症状。方法：总共招募了 391 名 Covid-19 RTPCR 阳性住院患者。所有纳入的受试者都收到了一份关于全身症状的问卷。为了分析症状的时间顺序，研究人群根据其全身受累的发作进行亚组，例如，(1) 发烧 (2) 呼吸系统症状 (3) 神经系统症状 (4) 胃肠道症状。结果：391 名患者中有 106 名 (27.1%) 出现新发神经系统症状，无论他们出现其他症状的时间顺序如何。在这 106 名患者中，味觉改变 (33.1%)、气味改变 (24.5%) 和头痛 (22.6%) 是最常见的神经系统症状。然而，38 名 (9.7%) 受试者认识到神经系统症状是他们疾病的最初表现。出现呼吸道症状或发热前神经系统症状的平均持续时间为 2 ± 1.57 天。结论：新发头痛、味觉和嗅觉改变是最常见的神经系统症状。在当前大流行的背景下，即使没有发烧和呼吸道症状，也应高度怀疑出现这些症状的患者。据我们所知，这是印度首次将神经系统症状与主要症状的年表进行比较的研究。