Observational cohort study of neurological involvement among patients with SARS-CoV-2 infection

Abstract

Background: A growing number of reports suggest that infection with SARS-CoV-2 often leads to neurological involvement; however, data on the incidence and severity are limited to mainly case reports and retrospective studies. Methods: This prospective, cross-sectional study of 102 SARS-CoV-2 PCR positive patients investigated the frequency, type, severity and risk factors as well as underlying pathophysiological mechanisms of neurological involvement (NIV) in COVID-19 patients. Results: Across the cohort, 59.8% of patients had NIV. Unspecific NIV was suffered by 24.5%, mainly general weakness and cognitive decline or delirium. Mild NIV was found in 9.8%; most commonly, impaired taste or smell. Severe NIV was present in 23.5%; half of these suffered cerebral ischaemia. Incidence of NIV increased with respiratory symptoms of COVID-19. Mortality was higher with increasing NIV severity. Notably, 83.3% with severe NIV had a pre-existing neurological co-morbidity. All cerebrospinal fluid (CSF) samples were negative for SARS-CoV-2 RNA, and SARS-CoV-2 antibody quotient did not suggest intrathecal antibody synthesis. Of the patients with severe NIV, 50% had blood–brain barrier (BBB) disruption and showed a trend of elevated interleukin levels in CSF. Antibodies against neuronal and glial epitopes were detected in 35% of the patients tested. Conclusion: Cerebrovascular events were the most frequent severe NIV and severe NIV was associated with high mortality. Incidence of NIV increased with respiratory symptoms and NIV and pre-existing neurological morbidities were independent risk factors for fatality. Inflammatory involvement due to BBB disruption and cytokine release drives NIV, rather than direct viral invasion. These findings might help physicians define a further patient group requiring particular attention during the pandemic.

MOG antibody-associated encephalitis secondary to Covid-19: case report

“…Recently, Fleischer et al described neurological symptoms in 60% of their 102 SARS-CoV-2 positive patients. Of those tested, 35% were reported to harbor serum autoantibodies against diverse neuronal and glial epitopes (no titers given), without specific clinical correlations [ 12 ]. Without giving further details, or neuroimaging data, they did not find a correlation between severity of disease and presence of anti-MOG antibodies.…”

COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)

“…The incidences of at least one new-onset neurological signs/symptoms in the context of COVID-19 infection were extremely wide-ranging, i.e., ~ 12 to ~ 85%. The wide extent of these percentages was based on retrospective and prospective studies from various countries: Austria (Zifko et al 2021); China (Mao et al 2020;Xiong et al 2020) Egypt (Khedr et al 2021); Iran (Amanat et al 2021;Ghaffari et al 2021); Italy (Benussi et al 2020;Rifino et al 2021;Travi et al 2021); France (Kremer et al 2020); Germany (Fleischer et al 2021); Mexico (Flores-Silva et al 2021); Pakistan (Iltaf et al 2020); Poland (Wnuk et al 2021); Portugal (Oliveira et al 2021); South Korea (Kim et al 2021);Spain (García-Azorín et al 2021a, b;García-Moncó et al 2020;García-Azorín et al 2021a, b;Romero-Sánchez et al 2020); Turkey (Karadaş et al 2020;Yuksel et al 2021); United States of America (Chachkhiani et al 2020;Eskandar et al 2021;Frontera et al 2021;Liotta et al 2020); multinational (Chou et al 2021). Systematic reviews with or without meta-analysis (Cagnazzo et al 2021;Chua et al 2020;Collantes et al 2021;Pinzon et al 2020;Romoli et al 2020;Tsai et al 2020;Vakili et al 2021) and narrative/ scoping reviews (Ahmed et al 2020;Maury et al 2021;Roy et al 2021...…”

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

“…Recently, two prospective studies on neurological symptoms in COVID-19 patients were performed, in which neurological consultation was used to identify neurological manifestations [6,7]. Fleischer et al showed that nearly 60% of 102 patients infected with the SARS-Cov-2 virus had non-specific neurological involvement with general weakness, cognitive decline or delirium [6]. In another study, the most common neurological complaints in a cohort of 873 Iranian patients were: smell and taste dysfunction, myalgia, headache, and dizziness [7].…”