About Richard Cole

Richard L. Cole, DC, DACNB, DAAPM, FICCN, FICC is a doctor of chiropractic, with advanced training in chiropractic neurology and pain management. Also, he is a fellow of the International College of Chiropractic Neurology and a fellow of the International College of Chiropractors.

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

Take Home Message

  • 36.4% of patients with Covid-19 exhibit neurological symptoms.
  • Chiropractic neurologist should be vigilant when examining patients with headache, dizziness, impaired smell and taste, impaired vision, musculoskeletal pain and nerve pain.
  • When examining patients even without fever, consider Covid-19 as a possible cause of the patients problem.


Importance  The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations.

Objective  To study the neurologic manifestations of patients with COVID-19.

Design, Setting, and Participants  This is a retrospective, observational case series. Data were collected from January 16, 2020, to February 19, 2020, at 3 designated special care centers for COVID-19 (Main District, West Branch, and Tumor Center) of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China. The study included 214 consecutive hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection.

Main Outcomes and Measures  Clinical data were extracted from electronic medical records, and data of all neurologic symptoms were checked by 2 trained neurologists. Neurologic manifestations fell into 3 categories: central nervous system manifestations (dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure), peripheral nervous system manifestations (taste impairment, smell impairment, vision impairment, and nerve pain), and skeletal muscular injury manifestations.

Results  Of 214 patients (mean [SD] age, 52.7 [15.5] years; 87 men [40.7%]) with COVID-19, 126 patients (58.9%) had nonsevere infection and 88 patients (41.1%) had severe infection according to their respiratory status. Overall, 78 patients (36.4%) had neurologic manifestations. Compared with patients with nonsevere infection, patients with severe infection were older, had more underlying disorders, especially hypertension, and showed fewer typical symptoms of COVID-19, such as fever and cough. Patients with more severe infection had neurologic manifestations, such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]), and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]).

Conclusions and Relevance  Patients with COVID-19 commonly have neurologic manifestations. During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.

Citation: Ling Mao; Huijuan Jin; Mengdie Wang; et al; Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. Published online April 10, 2020. doi:10.1001/jamaneurol.2020.1127

ICCN Supports AAPM DCs


The ICCN is now offering credentialing support for chiropractors board certified by the American Academy of Pain Management (AAPM) also known by its newer name the Academy of Integrative Pain Management (AIPM). The AAPM/AIPM went bankrupt in January 2019 leaving all members hanging. Some AAPM members had recently paid their fees and provided credentialing CE hours only to see it all evaporate.

The bankruptcy of the AAPM was blamed on declining membership, loss of revenue support from pharmaceutical companies and a reduction in conference revenue. However, it was also was tied to opioid lawsuits that were filed that taxed academy resources.


DAAPM MDs and nurses had a opportunity to join pain management organizations in their respective healthcare discipline but the chiropractors did not have a place to go. The Board of the ICCN decided to give our pain management brothers and sisters a hand and have formed a Pain Management (PM) committee functioning under the authority of the ICCN Board. The PM committee will support the pain management chiropractors board certified by the AAPM who wish for us to maintain their credentials.

The ICCN will recognize the DAAPM credential by endorsement. If we are legally blocked from supporting that credential, we are prepared to provide our own credential – the Diplomate of the International College of Pain Management (DICPM). However, since the AAPM is out of business, has no assets and no staff, we don’t believe there will be any reason why we cannot support the DAAPM credential. Similarly, we currently support the defunct American Chiropractic Academy of Neurology (DACAN) credential for some of our neurology diplomates.

There is no intention at present to provide a credential in pain management to non board certified chiropractors, but that remains a possibility. We are going slow at present, and take this step to support our credentialed PM brothers and sisters.

Neurologists boarded by the AAPM should contact the ICCN office if they are interested in maintaining their PM credential. If you know someone board certified by the AAPM, please let them know about this opportunity.