Abstract
Background: Nepal comes in the low-income nation with the health system working in very strenuous situation. Most of the health care is borne by the individual themselves. Even though geographically sitting close to China (where COVID-19 cases started) and India (where COVID-19 cases surged to the highest level), Nepal has been facing COVID-19 infection only recently. The exponential rise in cases, have brought the health system to the chaotic level. The late appearance of COVID-19 in Nepal has allowed us to understand more of the COVID-19 squeal.
Methods: A retrospective cases series of patients diagnosed with COVID-19 using reverse transcriptase polymerase chain reaction (rt-PCR) in nasopharyngeal swabs, who either first came with neurological symptoms or other symptoms were analyzed. The neurological disorder was diagnosed clinically with positive laboratory or imaging evidence. Results: Four patients were identified, median age 43.5 (range 28-57). Neurological disorders that were noted were seizure, ischemic stroke, and GuillainBarre syndrome (GBS).All patientshad history of taking antihypertensive drugs. None of them had any family history and were otherwise healthy. The blood work up of all these patientswas within normal limits, except in one patient who had marginally high glycosylated hemoglobin (HbA1C 7.2%).
Conclusion: COVID-19 can present with different kinds of symptoms. We believe this case series is first being reported from Nepal. Recently neurological disorder has been reported quite often. Hence, it is imperative that regardless of etiology,COVID-19 should be considered in the differential diagnosis for patients presenting with neurological disorder during the pandemic. Early consideration of COVID-19 thus may lead to earlier detection and appropriate precautions.
Keywords
COVID-19, Coronavirus, Cerebrovascular Disease, Neurological Disorder, Ischemic Stroke, Paralysis,