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 early in relatively mild infection. 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 Singapore healthcare system.

中文翻译：

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新加坡 COVID-19 的神经病学

目的 描述新加坡 COVID-19 神经病学的范围。方法 我们前瞻性地研究了新加坡所有经微生物学确诊的 COVID-19 患者，这些患者在 COVID-19 发病后三个月内因任何神经系统疾病而被转诊。神经学诊断和与 COVID-19 的关系是在同期文献的指导下达成的共识，并使用最近的病例定义进行了改进。结果 2020 年 3 月 19 日至 7 月 19 日期间，新加坡有 47,572 名患者（中位年龄 34 岁，98% 为男性）被诊断出患有 COVID-19。我们确定了 90 名患有神经系统疾病的患者（中位年龄为 38 岁，98.9% 为男性）；39 与 COVID-19 的关系确定性不同，分类为：i) 中枢神经系统综合征 - 4 急性播散性脑脊髓炎 (ADEM) 和脑炎，ii) 脑血管疾病 - 19 急性缺血性中风和短暂性脑缺血发作 (AIS/TIA)，4 脑静脉血栓形成 (CVT)，2 脑出血，iii) 周围神经系统 - 7 单/多发性神经病，以及一个新组，iv) 自主神经神经系统 - 4 限制性自主神经综合征。其他 51 名患者患有与 COVID-19 无关的神经系统疾病。脑炎/ADEM 发生延迟，发生在严重的 COVID-19 中，而 CVT 和自主神经功能障碍发生在相对较轻的感染早期。AIS/TIA 的发病率是可变的，发生在 COVID-19 严重程度不同的患者中；值得注意的是，63.2% 的人没有症状。CVT 比预期更频繁，发生在轻度/无症状患者中。所有 81 例儿科 COVID-19 病例均未出现神经系统并发症。结论 COVID-19 神经病学具有广泛的免疫障碍性血栓性疾病。我们遇到的神经系统并发症相对较少，可能是因为我们的爆发主要涉及患有轻度/无症状 COVID-19 的年轻男性。人们也普遍认为，大流行并没有对新加坡的医疗保健系统造成过度影响。