Annals of Indian Academy of Neurology
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Year : 2020  |  Volume : 23  |  Issue : 7  |  Page : 44

Alteration of consciousness as initial presentation in COVID-19: Observation

1 Sanitation1 Medical Academic Center, Bangkok, Thailand
2 Honorary Profeessor, Dr DY Patil University, Pune, India; Visiting Professor, Hainan Medical University, Haikou, China

Date of Submission26-Feb-2020
Date of Decision28-Feb-2020
Date of Acceptance28-Feb-2020
Date of Web Publication17-Apr-2020

Correspondence Address:
Beuy Joob
Sanitation1 Medical Academic Center, Bangkok
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_123_20

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How to cite this article:
Joob B, Wiwanitkit V. Alteration of consciousness as initial presentation in COVID-19: Observation. Ann Indian Acad Neurol 2020;23, Suppl S1:44

How to cite this URL:
Joob B, Wiwanitkit V. Alteration of consciousness as initial presentation in COVID-19: Observation. Ann Indian Acad Neurol [serial online] 2020 [cited 2021 Aug 2];23, Suppl S1:44. Available from:

To the Editor,

COVID-19 is a newly emerging respiratory disease that is caused by a novel coronavirus namely SARS-CoV- 2.[1] The disease was firstly reported from China, then it spread to several countries including Thailand.[2] In clinical neurology, the neurological manifestation of COVID-19 is interesting but little mentioned. Alteration of consciousness might be an initial presentation in coronavirus infection.[3] For COVID-19, the data on this issue is limited. Here, we would like to exchange the observation from Thailand, the second country in the world that this new respiratory disease existed.[2]

At present (February 22th, 2020), there are 35 patients with COVID-19 in Thailand. Of these 35 cases, no case had confusion as initial clinical presentation. From additional analysis on available data on 237 published cases in China,[4],[5] one patient had confusion as initial presentation giving the rate equal to 0.42% (95% confidence interval = 0.06% - 2.98%). The exact interrelationship between COVID-19 and confusion is still unknown. Based on these data, a few patients with COVID-19 might have confusion as an initial clinical presentation. If the practitioner does not recognize this possibility, the case might be missed.

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There are no conflicts of interest.

   References Top

Hsia W. Emerging new coronavirus infection in Wuhan, China: Situation in early 2020. Case Study Case Rep 2020;10:8-9.  Back to cited text no. 1
Yasri S, Wiwanitkit V. Editorial: Wuhan coronavirus outbreak and imported case. Adv Trop Med Pub Health Int 2019;9:1-2.  Back to cited text no. 2
Arabi YM, Harthi A, Hussein J, Bouchama A, Johani S, Hajeer AH, et al. Infection. Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV) 2015;43:495-501.  Back to cited text no. 3
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020. doi: 10.1001/jama. 2020.1585. [Epub ahead of print]  Back to cited text no. 4
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 5


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