The Spectrum of Neuro-COVID

Abstract

Background: Though reports of neurological manifestations of COVID-19 have emerged from various parts of the world, the cohorts reported are from the West and mostly derived from electronic databases. Much remains unknown regarding neuro-COVID in developing countries. India is the second-worst affected country, and this study reports the neurological manifestations of COVID-19 in a comprehensively evaluated cohort. Objective: The aim of this study was to describe the range of neurological manifestations of COVID-19 in India with an emphasis on the risk factors, laboratory and imaging findings and short-term outcome. Methods: Retrospective review of hospital records of all confirmed COVID-19 patients with neurological manifestations, receiving inpatient care in two neurology referral hospitals were done. All demographic, clinical details, investigations, and treatment were analysed. Results: A total of 120 confirmed COVID-19 cases presenting with neurological symptoms were included. The mean age of illness and duration of illness was 48.03 ± 17.3 years and 10.9 ± 17.3 days respectively. New onset of neurological symptoms occurred in 100 cases while 20 patients had worsening of pre-existing neurological illness. Stroke was the commonest neurological disorder (43%), followed by encephalopathy (23%) and Guillain-Barre syndrome (10%). Other unusual neurological manifestations included new-onset headache (7%), seizures including denovo status epilepticus (5%) and meningo-encephalitis (5%). Nearly half of the patients had preceding COVID-19 symptoms. Poor outcome at discharge was seen in 40% and mortality occurred in 15%. Conclusion: Stroke and encephalopathy constitute the most common neurological manifestations. The absence of preceding COVID-19 symptoms in nearly half the cases is striking. Poor outcome was seen in nearly 50% despite early recognition and management.

Magnetic Resonance Imaging-negative Acute Inflammatory Myelopathy following Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…With regard to neurological manifestations associated with COVID-19, several large-scale cohorts from different countries ( 1 - 6 ) and a wide variety of neurological syndromes have been reported. Among these, the most common diseases were stroke, encephalopathy, and headache ( 1 - 3 , 6 ).…”

“…With regard to neurological manifestations associated with COVID-19, several large-scale cohorts from different countries ( 1 - 6 ) and a wide variety of neurological syndromes have been reported. Among these, the most common diseases were stroke, encephalopathy, and headache ( 1 - 3 , 6 ). Compared to these diseases, AIM associated with COVID-19 seems to occur less frequently, as it has primarily been described in case reports ( 11 , 12 ).…”

“…In the early days of the COVID-19 pandemic in 2019, Mao et al (1) reported neurological complications in one-third of hospitalized patients in Wuhan, China. Several large-scale studies subsequently revealed a variety of neurologic complications of COVID-19, such as stroke, encephalopathy, headache, acute disseminated encephalomyelitis (ADEM), anosmia, cranial neuropathy, Guillain-Barré syndrome, and skeletal muscle injury (2)(3)(4)(5)(6). However, among the various neurological complications, inflammatory disease of the central nervous system (CNS) is relatively infrequently reported (6).…”