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

Abstract

Background COVID-19 disease affects the nervous system and led to an increase in neurological consults for patients at admission and through the period of hospitalization during the peak of the pandemic. Methods Patients with clinical and laboratory diagnosis of COVID-19 that required a neurologic consultation or those who presented with neurological problems on admission that led to a diagnosis of SARS-CoV-2 infection during a 2-month period at the peak of the pandemic were included in this study. Demographic and clinical variables were analyzed. Results Thirty-five patients were included. The presenting neurologic manifestations on admission led to the diagnosis of COVID-19 in 14 patients (40%). The most common reasons for consultation during the hospitalization period were stroke (11), encephalopathy (7), seizures (6), and neuropathies (5) followed by a miscellaneous of syncope (2), migraine (1), anosmia (1), critical illness myopathy (1), and exacerbation of residual dysarthria (1). The most common neurological disturbances were associated with severe disease except for neuropathies. Patients with encephalopathies and seizures had markedly increased D-dimer and ferritin values, even higher than stroke patients. RT-PCR was performed in 8 CSF samples and was negative in all of them. Conclusion Neurological disturbances represent a significant and severe burden in COVID-19 patients, and they can be the presenting condition that leads to the diagnosis of the viral infection in a high percentage of patients. Evidence of direct viral mechanisms was scarce, but the pathogenesis of the diverse manifestations remains enigmatic.

Hemorrhagic and ischemic stroke in patients with coronavirus disease 2019: incidence, risk factors, and pathogenesis - a systematic review and meta-analysis

“…Only 16 studies were included in the meta-analysis to calculate the global prevalence of ischemic stroke in COVID-19 patients and the frequency of symptoms leading to hospital admission 34 – 49 . Data from six studies were included to calculate the mortality rate of ischemic stroke in COVID-19 patients 35 – 37 , 40 , 48 , 49 , as no relevant data was reported in the remaining 12 studies.…”

Integrative analyses identify susceptibility genes underlying COVID-19 hospitalization

“…Genetically predicted expression of IFNAR2 was associated with migraine in BioVU patients without severe COVID-19. Given that more than 10% of the COVID-19 diagnosed individuals requiring hospitalization reported migraine and headache symptoms ( 27, 28 ), we hypothesize that reduced host expression of IFNAR2 may modulate risk for migraine symptoms in the context of severe COVID-19 infection.…”

Syncope and COVID-19 disease – a systematic review

“…Of the 19 included articles, 8 were case reports (8) (9) (10) (11) (12) (13) (14) (15), 6 were retrospective analyses (3) (7) (16) (17) (18) (19), 3 were case-series (6) (20) (21) and 2 were prospective studies (22) (23). Given the nature of the topic at hand, every article was published in 2020.…”

“…The majority of studies, 8, described syncopal episodes of unspecified etiology. (3) (7) (16) (17) (18) (21) (22) (23) Six studies attributed the cause to orthostatic hypotension (3) (6) (8) (12) (14) (15), while another 5 studies alluded to possible cardiac syncope (3) (9) (10) (11) (13). In turn, reflex syncope was highlighted in 4 of the studies.…”

“…Orthostatic hypotension accounted for 3.6% (9/248) and presumable cardiac syncope was responsible for 2.0% (5/248). Regarding comorbidities, hypertension was heavily represented in 11 studies (3) (6) (7) (8) (9) (14) (16) (19) (20) (21) (22), making it the most prevalent comorbid condition exhibited by the participants. This was closely followed by Diabetes mellitus, obesity, dyslipidemia and heart disease.…”