Neuro‐COVID frequency and short‐term outcome in the Northern Portuguese population

Abstract

Background and purpose: COVID-19-related acute neurological phenotypes are being increasingly recognised, with neurological complications reported in more than 30% of hospitalised patients. However, multicentric studies providing a population-based perspective are lacking. Methods:We conducted a retrospective multicentric study at five hospitals in Northern Portugal, representing 45.1% of all hospitalised patients in this region, between 1 March and 30 June 2020.Results: Among 1261 hospitalised COVID-19 patients, 457 (36.2%) presented neurological manifestations, corresponding to a rate of 357 per 1000 in the North Region. Patients with neurologic manifestations were younger (68.0 vs. 71.2 years, p = 0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%), and impairment of consciousness (9.7%). Acute well-defined central nervous system (CNS) involvement was found in 19.1% of patients, corresponding to a rate of 217 per 1000 hospitalised patients in the whole region. Assuming that all patients with severe neurological events were hospitalised, we extrapolated our results to all COVID-19 patients in the region, estimating that 116 will have a severe neurological event, corresponding to a rate of nine per 1000 (95% CI = 7-11). Overall case fatality in patients presenting neurological manifestations was 19.8%, increasing to 32.6% among those with acute well-defined CNS involvement. Conclusions:We characterised the population of hospitalised COVID-19 patients in Northern Portugal and found that neurological symptoms are common and associated with a high degree of disability at discharge. CNS involvement with criteria for in-hospital admission was observed in a significant proportion of patients. This knowledge provides the tools for adequate health planning and for improving COVID-19 multidisciplinary patient care.

Neurologic complications of coronavirus and other respiratory viral infections

“…Uncertain evidence for systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant) ( Vaira et al, 2021 ). Seizures Retrospective cohort studies report a seizures prevalence between 0.06% and 1.5% of hospitalized patients ( Rogers et al, 2021 ; Oliveira et al, 2021 ). Many cases with new-onset focal seizures, serial seizures, and status epilepticus have been reported in the literature ( Asadi-Pooya et al, 2021 ).…”

“…Seizures rarely represent the presenting symptoms of the infection ( Fasano et al, 2020 ). Retrospective cohort studies have estimated the seizure prevalence ranging from 0.06% to 1.5% of COVID-19 patients ( Oliveira et al, 2021 ; Rogers et al, 2021 ). The etiology of seizures is most likely multifactorial, depending on patients’ characteristics (in particular, comorbidities such as diabetes or kidney disease), severity of the systemic infection that can lead to multiorgan failure, metabolic issues, or severe systemic hypoxemia with anoxic/hypoxic brain injury, drug interactions, specific neurologic involvement with brain damage (encephalitis or cerebrovascular events), and direct viral neuroinvasion ( Emami et al, 2020 ; Asadi-Pooya et al, 2021 ; Pizzi, 2021 ).…”

Neuropathological findings from COVID‐19 patients with neurological symptoms argue against a direct brain invasion of SARS‐CoV‐2: A critical systematic review

“…Although involvement of the respiratory system is the most relevant clinical feature in COVID‐19 patients, neurological symptoms have been widely reported [6−8]. Neurological manifestations associated with SARS‐CoV‐2 infection can affect both the central and peripheral nervous system and range widely from mild taste and smell disturbances to more serious conditions, such as acute cerebrovascular disease, disseminated encephalomyelitis, or Guillain‐Barré syndrome [6−10].…”

Neuro‐COVID‐19

“…It has been reported that COVID‐19 is associated with a variety of serious neuromuscular complications (Table 2 ), and that these complications worsen the prognosis. 6 However, some of the evidence is based on a small number of case reports or case series, and the possibility that the complications occurred by chance at a time after the onset of COVID‐19 cannot be ruled out. A proof of causality is required to confirm the epidemiological increase in the incidence and/or to elucidate the pathogenic mechanism.…”