Clinical Spectrum and Neuroimagistic Features in Hospitalized Patients with Neurological Disorders and Concomitant Coronavirus-19 Infection

Abstract

In the first months of the COVID-19 pandemic, several research studies focused on understanding the damage to the respiratory and circulatory systems. However, the evidence of neurological manifestations as part of the clinical spectrum of the disease has increased. The aim of this retrospective study was to determine the potential association of neurological disorders with concomitant COVID-19 infection. We reviewed 101 patients (mean age, 70.05 years; 62.37% men) diagnosed with different neurological disorders and COVID-19 who were referred to the Department of Neurology between March 2020 and May 2021. The protocol included demographic, clinical, and neuroimagistic features, biochemical evaluation data, and prognosis. In the first group of patients with non-severe COVID-19 infection (<50% lung damage), we enrolled 75 cases (mean age, 69.13 years; 65.33% men), and the second group, with 26 patients (mean age, 72.69 years; 53.84% men), developed severe COVID-19 infection (>50% lung damage). Severe COVID-19 infection was significantly correlated with an increased highly sensitive C-reactive protein level (hsCRP) (p < 0.05), lactate dehydrogenase level (LDH) (p < 0.05), erythrocyte sedimentation rate (ESR) (p < 0.05), D-dimer (p < 0.05), fibrinogen level (p < 0.05), and blood glucose (p < 0.05) when compared to the first group. These biochemical parameters were increased in both groups, but the levels were much higher in the second group. Headaches (72.27%) and dizziness (14.85%) were present in the early stage of infection. Cerebrovascular events were also reported: ischemic stroke (48% vs. 57.69%; p < 0.05), cerebral hemorrhage (4.95%), and cerebral venous sinus thrombosis (1.98%). Encephalitis (1.98%) and Guillain–Barré Syndrome (1.98%) were found but less frequently. Cranial nerve abnormalities were statistically more common in the non-severe group: anosmia (32% vs. 26.92%; p < 0.05), dysgeusia/ageusia (48% vs. 42.30%; p < 0.05), impaired eye movement (1.33% vs. 0%), and facial nerve palsy (2.66% vs. 0%). Seizures (13.33% vs. 11.53%; p < 0.05) and a depressed level of consciousness (31.68%) occurred commonly. We detected the neuropsychiatric symptoms of anxiety (23.76%) and depression (14.85%). Mortality was increased in both groups but was much higher in the second group (46.15% vs. 21.33%). Neurological complications during COVID-19 infection are common in hospitalized patients, but the mechanism of these complications is not fully understood, representing a continuous challenge for neurologists.

The Immediate Onset of Isolated and Unilateral Abducens Nerve Palsy Associated with COVID-19 Infection: A Case Report and Literature Review

“…In a recent study focusing on hospitalized COVID-19 patients with neurological disorders, cerebrovascular events were particularly prominent in cases of severe lung damage, which was accompanied by increased C-reactive protein and D-dimer levels. Although the involvement of eye movement disorder was observed in only 1.33% of individuals in this cohort, most of these cases were seen in the non-severe group ( 16 ). These findings suggest that cerebrovascular events do not always correlate with eye movement disorders.…”

Tolosa–Hunt Syndrome and Hemorrhagic Encephalitis Presenting in a Patient after COVID-19 Vaccination Followed by COVID-19 Infection

“…A substantial number of patients having a COVID-19 infection had acute cerebrovascular events, including ischemic stroke [ 4 ]. The general incidence of encephalitis in COVID-19 patients is less than 1 percent, but may reach as high as 6 to 7 percent in patients with severe illness [ 10 ].…”

“…The clinical symptoms, such as a low state of consciousness, seizures, headache, and motor impairments, are comparable to those of other types of encephalitis; however, the mortality rate was determined to be around 13 percent, which is considerably higher compared with other types of encephalitis [ 11 ]. Encephalitis may present with meningeal and parenchymal symptoms, white matter inflammation, vasculitis, and, in rare cases, hemorrhagic encephalitis [ 4 , 12 ]. The mechanism of hemorrhagic encephalitis secondary to COVID-19 is multifactorial but incompletely known.…”

“…This autoimmune phenomenon has been associated with numerous reported triggers, including COVID-19 vaccination or infection with COVID-19 [ 2 , 3 ]. The antibodies originate from the immunological system of the host to oppose the cross-reacted virus and bind to the cranial/peripheral nerves, causing neuronal impairments [ 4 , 5 ].…”

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

“…A history of stroke was found to independently predicate in-hospital mortality in a large cohort of more than 3000 patients with COVID-19 hospitalized in the Mount Sinai Health System in New York [ 52 ]. Similarly, in a Romanian study where nearly 8% of COVID-19 patients had a prior stroke, the presence of a preexisting neurological disorder was highly correlated with SARS-CoV-2 infection severity [ 53 ].…”