Neurological Presentations of COVID-19: Characteristic Features in a Case Series of Hospitalized Patients from Abu Dhabi, UAE

Abstract

Background. COVID-19 patients can present with neurological manifestations in the form of headache, dizziness, hyposmia, myalgia, peripheral neuropathy, acute cerebrovascular disease, and encephalopathy. Neurological involvement could be due to virus-induced brain hypoxia, brain infection, or immune reaction. We aim to describe the neurological presentation of COVID-19 patients and study their neuroimaging findings and disease outcome. Method. The study is a single-centre, retrospective, observational study in Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Patients diagnosed with COVID-19 between March and May 2020 who presented with neuropathological features with or without respiratory manifestations of COVID-19 were enrolled. Electronic records were studied for age, sex, duration of hospitalization, detailed neurological presentation, history or documented concomitant fever and respiratory features of COVID-19, inflammatory markers, neuroimaging, progress, and disease outcome. Results. Thirty-three patients of 10 nationalities presented with neurological manifestations. Mean (range) age was 51.4 (21–86) years. Twenty-four had comorbidities, and 18 had no prior or concomitant respiratory symptoms. Ten patients presented with encephalopathy and exhibited altered behavior/sensorium: 7 presented with myositis, 8 with stroke, and 4 with seizures, and 4 had peripheral and cranial nerve involvement. The mean (average) duration of hospital stay was 11.4 days (1-38) with the longest observed in stroke patients. Fifteen patients (45%) died and 3 (9%) had residual weakness. Serum ferritin, CRP, and procalcitonin were higher in the severe disease group and correlated with risk of death. Twelve of 22 brain images showed abnormalities including haemorrhage, infarcts, small vessel ischemia, and oedema. Risk of death was higher in older age but did not differ based on the underlying neuropathology. Conclusion. COVID-19 patients who present with neurological involvement have a higher risk of mortality which is aggravated by older age and higher inflammatory markers. The type of neurological pathology does not seem to influence the risk of mortality.

Clinical and laboratory characteristics of children with neurological presentations of COVID-19: a single-center experience

“…This represents one major difference from the adult population in which the prognosis of COVID-19 cases with neurological presentation had shown a higher risk of mortality regardless of the type of neurological pathology. The risk is aggravated by older age and higher inflammatory markers [ 24 , 25 ]. The current study had several limitations.…”

Manifestações neurológicas em adultos diagnosticados com COVID-19

“…A média de idade foi de 61 anos, houve prevalência de contágio da doença, percentual e absoluta, pelo sexo masculino, O sintoma de convulsão foi o sintoma que apresentou a menor incidência entre os pesquisados, sendo diagnosticado ao total em 65 pacientes de 3.791 que apresentaram sintomas neurológicos durante o diagnóstico de COVID-19, correspondendo percentualmente a 0,01% (Chuang, D. et al 2021;Deeb, A. et al 2021;Flores-Silva et al 2020;Sherry, et al 2020).…”

“…et al 2020). Com relação a avaliação sintomatológica de sintomas neurológicos com acometimento periférico, os pacientes diagnosticados com mialgia, apresentaram diferentes prevalências, sendo assim respectivamente suas incidências de 46% e 21% (Deeb, A. et al 2021;Flores-Silva F.D. et al 2020).…”

“…A astenia, outro sintoma neurológico periférico inespecífico, apresentou sua sintomatologia variada, apresentando incidência respectivamente de 5,1%, 6 % dentre os estudos que avaliaram este sintoma (Deeb, et al 2021;Flores-Silva et al 2020).…”

“…As evidências acerca do acometimento neurológico do SARS-Cov-2, de acordo com as avaliações clínicas iniciais, denotam manifestações por sintomas como anosmia, disgeusia, mialgia e cefaléia durante o curso inicial da doença (Wang, et al 2020 ;Xie, et al 2020 ;Zhou, et al 2020 ;Zubair, et al 2020). Muitas hipóteses foram sugeridas sobre como o vírus atinge o sistema nervoso levando a tais sintomas, incluindo sua entrada potencial através do sulco olfatório ou corrente sanguínea (Baig, A.M. et al 2020;Deeb, A. et al 2021;Jiménez et al 2020).…”