Neurological Manifestation on Hospitalized Patient With Probable Covid-19 in Saiful Anwar Hospital Indonesia (Serial Cases)

Abstract

Background: Coronavirus disease 2019 (Covid-19) caused by SARS-Cov-2 had been spreading worldwide including Indonesia, but In Indonesia, it was difficult to diagnose confirmation Covid-19 by Polymerase Change Reaction (PCR). and in clinical practice to treat covid-19, Indonesia Health Ministry use term probable covid-19 for patients under observation Covid-19, but study for neurological manifestation on probable Covid-19 is very lacking. Objective: Knowing the neurological manifestation of patient probable Covid-19. Methods: Observational study from Covid-19 medical record and neuro-Covid-19 medical record of all probable Covid-19 hospitalized in the isolation ward of Saiful Anwar Hospital (RSSA) Malang since March-May, 2020 (3 months). Probable Covid-19 criteria were given by Covid-19 task force team based on Health Minister Indonesia criteria. This criterion was based on clinical manifestation (severe upper respiratory symptoms, or mild-severe pneumonia), radiologic examination (lung infiltrate and or chest CT scan), and laboratory examination. Neurological manifestation is based on clinical symptom appeared while patient hospitalized, supported with radiologic and laboratory data which was supervised by neurologist or neurologist resident. All data was inputted to neuro-Covid-19 e-registry on the smartphone application, sent periodically to the data center in Neurology Department RSSA Malang. Results: A hundred and fourteen probable Covid-19 was registered with mean age 34,5 year old and mostly at the young age of 20-50 years (38%). The neurological manifestation was observed in 4 patients (3,4% from all possible Covid-19 patients) with thrombotic stroke as the most common manifestation (50%), followed by myelum tumor (25%) and hypoxia encephalopathy (25%). Stroke patients in probable Covid-19 had old age (72 and 82 years) accompanied by several comorbid such as hypertension, DM and CVA history and Covid symptoms of cough, shortness of breath and fever. Hemiparesis was found improved with aspirin and neurotropic therapy. Patient with myelum tumor had a covid symptom of shortness of breath, cough, and fever with UMN tetraparesis. Previous MRI examination results suspected meningioma. The patient died while hospitalized. Patients with hypoxia encephalopathy admitted with decreased consciousness due to shortness of breath with acidosis respiratory symptoms (pH 7,22 ). This condition improved after oxygenation without focal neurologic deficit. Conclusion:Neurological manifestation in probable Covid-19 was 3,4% of all patients. The most common diagnosis was a thrombotic stroke, followed by myelum tumor, hypoxia encephalopathy, and mortality rate is 25%.

The Incidence and Mortality Ratio of Ischemic Cerebrovascular Accidents in COVID-19 Cases: A Systematic Review and Meta-Analysis

“…This ratio was also higher in males who were had acute ischemic CVA. 13,17,22,[25][26][27][28][29][30] Regarding the mean age of the patients suffering from acute ischemic CVA, with a COVID-19 infection, almost all of the included reports showed a mean age of at least 60 years old. Only two studies reported a lower mean of age, 14,23 and one of them had only included patients below 50 years of age.…”

COVID-19 and its impact on neurological manifestations and mental health: the present scenario

“…Autopsy reports of deceased COVID-19 patients revealed brain tissue oedema and partial neuronal degeneration [23]. Badrul et al, from Indonesia, reported neurological manifestations in 3-4% out of 114 COVID-19-infected patients; thrombotic stroke was the most common followed by myeloid tumours and hypoxic-ischemic encephalopathy (HIE) [41]. Farzad et al reported a series of six patients younger than 55 years of age affected with COVID-19 and diagnosed with stroke.…”

Fatality Case in a Tuberculous Meningoencephalitis Patient Coinfected with COVID-19

“…In Indonesia, the number of tuberculosis cases found and treated in 2020 was 344,992, with 11% being extrapulmonary tuberculosis (6). Emerging at the end of 2019, COVID-19 has infected 60 million people and caused 1.5 million deaths worldwide.…”

“…An exaggerated inflammatory response causes damage to these organs. Although most symptoms are in the respiratory sys-tem, neurological manifestations are often found, proving that COVID-19 may act as an opportunistic pathogen in the nervous system, especially the brain (6,8,9). Several neurological manifestations were found, including stroke, polyneuropathy, myopathy, and seizures, but there are still limited data about COVID-19 in tuberculous meningoencephalitis (4,9).…”