Neurological Manifestations in Critically Ill Patients With COVID-19: A Retrospective Study

Abstract

Background: The complications of coronavirus disease 2019 (COVID-19) involved multiple organs or systems, especially in critically ill patients. We aim to investigate the neurological complications in critically ill patients with COVID-19. Methods: This retrospective single-center case series analyzed critically ill patients with COVID-19 at the intensive care unit of Tongji Hospital, Wuhan, China from February 5 to April 2, 2020. Demographic data, clinical and laboratory findings, comorbidities and treatments were collected and analyzed. Results: Among 86 patients with confirmed COVID-19, 54 patients (62.8%) were male, and the mean (SD) age was 66.6 (11.1) years. Overall, 65% patients presented with at least one neurological symptom. Twenty patients (23.3%) had symptoms involving the central nervous system, including delirium, cerebrovascular diseases and hypoxic-ischemic brain injury, while 6 patients (7%) had neuromuscular involvement. Seven of 86 patients exhibited new stroke and 6 (7%) cases were ischemic. A significantly higher prevalence of antiphospholipid antibodies was observed in patients with ischemic stroke than in those without stroke (83.3 vs. 26.9%, p < 0.05). Patients with ischemic stroke were more likely to have a higher myoglobulin level, and a lower hemoglobin level. Conclusions: The clinical spectrum of neurological complications in critically ill patients with COVID-19 was broad. Stroke, delirium and neuromuscular diseases are common neurological complications of COVID-19. Physicians should pay close attention to neurological complications in critically ill patients with COVID-19.

Stroke in COVID-19: A systematic review and meta-analysis

“…The severity of the infective disease consistently emerged as an important risk factor for stroke across different studies (18,23,24). Moreover, we found that people with COVID-19 developing a stroke were older than infected patients without stroke.…”

“…It may also reflect differences in healthcare system organization, and intensity of neurologic screening. Overall, we recorded the highest stroke rates in Asian populations (18,23).…”

“…This coagulopathy, termed "sepsis-induced coagulopathy" (SIC), is related to the infection-induced systemic inflammatory response and may contribute to the increased risk of thrombosis and stroke (40,41). Also, the presence of antiphospholipid antibodies (aPL), including IgA anticardiolipin antibodies and IgA and IgG beta 2 glycoprotein I antibodies, has been reported in severely infected patients with multiple cerebral infarcts (23,42). Hypercoagulation could lead to ischemic stroke promoting venous thromboembolism and paradoxical embolism; this could explain stroke from large vessel occlusion in young people without vascular risk factors, where plaque rupture or in situ thrombosis seem less likely(31).…”

COVID-19: patients with stroke or risk of stroke

“…A significantly higher prevalence of antiphospholipid antibodies was described in the seven brain-infarct patients (83.3 vs. 26.9%, P < 0.05). 11 In a cohort study including 187 patients at Montefiore Medical Center in the Bronx, New York, an increased incidence of Lupus Anticoagulans (LA) positivity was found in patients with COVID-19 after adjusting for C-reactive protein (CRP) levels. In addition, of the 30 patients who were LA positive, 19 had documented thrombosis (arterial and venous) including 2 strokes, an event rate of 63%, as compared with a rate for LA-negative patients of 34% ( P = 0.03).…”

Schlaganfall und COVID-19

“…Ein Patient verstarb, die anderen konnten innerhalb von 14 Tagen wieder entlassen werden[6].Bei 86 schwer erkrankten COVID-19-Patienten aus China hatten 6 einen neu aufgetretenen ischämischen Schlaganfall, ein Patient eine Hirnblutung. Beschrieben wurde eine signifikant höhere Prävalenz von Antiphospholipid-Antikörpern bei den Hirninfarktpatienten (83,3% vs. 26,9 %, p < 0,05)[7]. Eine Arbeitsgruppe aus Spanien hat ihre Ergebnisse zu Schlaganfällen im Rahmen der CO-VID-19-Pandemie vorgelegt[8].In dem Krankenhaus wurden im März und April 2020 1683 Patienten mit COVID-19 eingewiesen, von denen 23 (1,4 %) einen Schlaganfall hatten.…”