Neurologic Manifestations in a Prospective Unselected Series of Hospitalized Patients With COVID-19

Abstract

Objective:Increasing number of neurological problems are being described in COVID-19 disease, but their frequency and type have not been defined. In this study we sought to determine the extent of neurological manifestations of COVID-19 in a prospective series of unselected patients admitted to the general medicine wards of our hospitals due to COVID-19 and who were examined by a team of neurologists.Methods:Eight neurologists provided medical attention to patients hospitalized for COVID-19 to provide medical support to other hospital units tasked with the care of an increasingly larger influx of COVID-19 patients. A series of 100 consecutive, unselected patients were evaluated systematically, including a questionnaire that collected medical information derived from the initial exam and the medical history.Results:Eighty-eight percent of the patients had one neurological manifestation associated with COVID-19 during hospitalization. Most common were anosmia-dysgeusia and headache (44% each), myalgias (43%), and dizziness (36%). Less frequent were encephalopathy (8%), syncope (7%), seizures (2%), and ischemic stroke during the period of hospitalization (2%). Anosmia and headache associated with younger patients with less severe disease, and both were associated with each other and with serum inflammatory markers. Encephalopathy was associated with fever and syncope and with markers of inflammation.Conclusions:Neurological disturbances are common in COVID-19 patients, particularly if patients are evaluated by neurologists. There is a wide variety of neurological conditions, some of them severe, in the spectrum of COVID-19 disease that will benefit from an evaluation by practicing neurologists.

Neurological presentations of COVID-19: Findings from the Spanish Society of Neurology neuroCOVID-19 registry

“…Neurological symptoms are the most frequent extra-pulmonary symptoms of the virus. They are described in 36.4%–57.4% of hospitalised patients [ [5] , [6] , [7] , [8] , [9] ] and 84% of patients admitted to intensive care units [ 14 ]. Neurological symptoms have been classified according to the anatomical location of the lesion, into symptoms originating in the central nervous system, symptoms originating in the peripheral nervous system, and muscular manifestations [ 5 ].…”

“…In our opinion, the term “non-specific” can be confusing, as no pathognomonic sign or symptom of neuroCOVID-19 has yet been identified. We could classify neurological symptoms into non-focal, generalised symptoms, such as myalgia, headache, anosmia, light-headedness, and altered mental status; and focal symptoms, including stroke, seizures, radiculopathies, cranial nerve syndromes, encephalitis, and movement disorders [ 8 , 9 ].…”

“…The first large series described a relatively low frequency of mostly non-specific neurological symptoms, including myalgia, headache, anosmia, and altered mental status [ [4] , [5] , [6] , [7] ]. However, since the publication of the initial neurological series and cases, the number and frequency of neurological manifestations have significantly increased [ 8 , 9 ]. The SEN created a nation-wide registry of COVID-19 cases with neurological manifestations [ 10 ].…”

Neurological reasons for consultation and hospitalization during the COVID-19 pandemic

“…The apparently low number of neurological consultations during the initial pandemic wave may have reflected an underestimation of the neurological abnormalities in severely compromised respiratory patients. A systematic neurologic evaluation of a series of unselected, consecutively hospitalized patients in our center showed a high frequency of neurological disturbances [8].…”

“…Neurological disturbances are an increasingly recognized part of the clinical spectrum of COVID-19 [1][2][3][4][5][6][7][8][9][10][11]. This has represented a diagnostic and therapeutic challenge for the attending neurologist, particularly if one considers the difficulties in performing routine ancillary examinations in these patients in isolation with such a contagious condition.…”