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Title: Neurology of COVID-19 in Singapore
Authors: Koh, JS 
De Silva, DA 
Quek, AML 
Chiew, HJ 
Tu, TM 
Seet, CYH 
Hoe, RHM
Saini, M
Hui, ACF
Angon, J
Ker, JR
Yong, MH 
Goh, Y
Yu, WY 
Lim, TCC 
Tan, BYQ
Ng, KWP 
Yeo, LLL 
Pang, YZ 
Prakash, KM 
Ahmad, A 
Thomas, T 
Lye, DCB 
Tan, K 
Umapathi, T
Keywords: COVID-19
Neurological manifestations
Issue Date: 15-Nov-2020
Publisher: Elsevier BV
Citation: Koh, JS, De Silva, DA, Quek, AML, Chiew, HJ, Tu, TM, Seet, CYH, Hoe, RHM, Saini, M, Hui, ACF, Angon, J, Ker, JR, Yong, MH, Goh, Y, Yu, WY, Lim, TCC, Tan, BYQ, Ng, KWP, Yeo, LLL, Pang, YZ, Prakash, KM, Ahmad, A, Thomas, T, Lye, DCB, Tan, K, Umapathi, T (2020-11-15). Neurology of COVID-19 in Singapore. Journal of the Neurological Sciences 418 : 117118-. ScholarBank@NUS Repository.
Abstract: © 2020 Elsevier B.V. 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.
Source Title: Journal of the Neurological Sciences
ISSN: 0022510X
DOI: 10.1016/j.jns.2020.117118
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