When to Test Primary Neurologic Patients for Covid-19 Infection

Introduction: Patients with Covid-19 have been found to present with neurologic manifestations prior to or even without manifestation of typical symptoms These patients may not be considered as potential Covid-19 patients as they may present without fever, chills, or shortness of breath This may subsequently place patients and staff at risk for preventable exposure and, therefore, knowledge on this subject area should be expanded with further studies and retrospective reviews Guidelines should be implemented in respective hospital facilities to guide healthcare providers on when to test a patient presenting for new or worsening neurologic symptoms that may be related to infection with 2019-nCoV Resources for testing are limited and placing a patient under investigation for 2019-nCoV infection requires use of limited personal protective equipment, increases the patient burden on already overwhelmed staff, and places the patient under stringent precautions and isolation Therefore, selection of patients for testing should be carefully considered Methods: Literature review pertaining to pathophysiology, presentation of, and neurologic complications of 2019-nCoV was performed and combined with first hand clinical experience in Covid-19 patients with neurologic symptoms Findings: Patients with new or worsening neurologic symptoms that cannot otherwise be explained by underlying mechanisms should be considered for testing In our hospital of mainly Hispanic patients, presentations and sequelae of Covid-19 have included new onset generalized seizures, large vessel occlusions, encephalopathy, headache, and others in a wide array of patients with and without cardiovascular or neurologic risk factors These presentations may occur in patients with no previous history of neurologic disease or in patients with pre-existing neurologic disease Discussion and Conclusion: We propose an algorithm to help clinicians determine atypical testing candidates for COVID-19 as well as what risk factors need to be identified, what lab values should be considered, and what limitations are posed along with mitigation strategies Further studies should be preformed to assess for statistical significant of neurologic symptoms in Covid-19 patients