Neurological manifestations and COVID-19: Experiences from a tertiary care center at the Frontline

J Neurol Sci. 2020 Aug 15;415:116969. doi: 10.1016/j.jns.2020.116969. Epub 2020 Jun 3.

Abstract

Objective: To report neurological manifestations seen in patients hospitalized with Coronavirus disease 2019 (COVID-19) from a large academic medical center in Chicago, Illinois.

Methods: We retrospectively reviewed data records of 50 patients with COVID-19 who were evaluated by the neurology services from March 1, 2020 - April 30, 2020. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the "Neuro first" group had neurological manifestations upon initial assessment, and the "COVID first" group developed neurological symptoms greater than 24 h after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms and diagnoses of both groups were analyzed. Statistical analysis was performed to compare the two groups.

Results: A total of 50 patients (48% African American and 24% Latino) were included in the analysis. Most common neurological manifestations observed were encephalopathy (n = 30), cerebrovascular disease (n = 20), cognitive impairment (n = 13), seizures (n = 13), hypoxic brain injury (n = 7), dysgeusia (n = 5), and extraocular movement abnormalities (n = 5). The "COVID-19 first" group had more evidence of physiologic disturbances on arrival with a more severe/critical disease course (83.3% vs 53.8%, p 0.025).

Conclusion: Neurologic manifestations of COVID-19 are highly variable and can occur prior to the diagnosis of or as a complication of the viral infection. Despite similar baseline comorbidities and demographics, the COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses. Differently from previous studies, we noted a high percentage of African American and Latino individuals in both groups.

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Chicago / epidemiology
  • Comorbidity
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nervous System Diseases / epidemiology*
  • Nervous System Diseases / physiopathology
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / physiopathology*
  • Retrospective Studies
  • SARS-CoV-2
  • Tertiary Care Centers*
  • Time Factors