Neurological presentations of COVID-19: Findings from the Spanish Society of Neurology neuroCOVID-19 registry

J Neurol Sci. 2021 Apr 15;423:117283. doi: 10.1016/j.jns.2020.117283. Epub 2020 Dec 19.


Objective: We report the findings from the Spanish Society of Neurology's NeuroCOVID-19 Registry.

Methods: We performed a multicentre study of patients with neurological manifestations of COVID-19. Participating physicians reported demographic, clinical, and paraclinical data and judged the involvement of COVID-19 in causing neurological symptoms.

Results: A total of 233 cases were submitted, including 74 different combinations of manifestations. The most frequently reported were stroke (27%), neuromuscular symptoms (23.6%), altered mental status (23.6%), anosmia (17.6%), headache (12.9%), and seizures (11.6%). The mean age of patients was 61.1 years, with 42.1% being women; a higher proportion of women was recorded among patients with altered mental status, anosmia, and headache. The onset of symptoms differed within categories. Onset of anosmia occurred a mean (standard deviation) of 2.9 (2.5) days after the first general symptom, whereas neuromuscular symptoms appeared after 13.9 (10.1) days. Neurological symptoms were persistent in 33% of patients. General symptoms were present in 97.7% of patients, and results from general laboratory studies were abnormal in 99.4% of patients. Cerebrospinal fluid analysis findings were abnormal in 62.7% of the cases in which this test was performed (n = 51), but positive results for SARS-CoV-2 were only found in one case.

Conclusions: The neurological manifestations of COVID-19 are diverse. Anosmia, myalgia, and headache occur earlier in the course of the disease. Altered mental status, neuromuscular symptoms, and stroke are associated with greater severity. COVID-19 must be incorporated into most clinical and radiological differential diagnoses. COVID-19 may cause persistent and disabling neurological symptoms.

Keywords: COVID-19; Cerebrospinal fluid; Delirium; Epilepsy; Headache disorders; Stroke.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Anosmia / epidemiology
  • Anosmia / etiology
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology
  • COVID-19 Testing
  • Cardiovascular Diseases / epidemiology
  • Causality
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Female
  • Headache / epidemiology
  • Headache / etiology
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / etiology
  • Middle Aged
  • Myalgia / epidemiology
  • Myalgia / etiology
  • Nervous System Diseases / cerebrospinal fluid
  • Nervous System Diseases / diagnostic imaging
  • Nervous System Diseases / epidemiology
  • Nervous System Diseases / etiology*
  • Neuroimaging
  • Neurologic Examination
  • Neuromuscular Diseases / epidemiology
  • Neuromuscular Diseases / etiology
  • Registries
  • SARS-CoV-2* / pathogenicity
  • Spain / epidemiology
  • Stroke / epidemiology
  • Stroke / etiology
  • Treatment Outcome
  • Virulence