Abstract:Background/Objective: There have been numerous reports of neurological manifestations identified in hospitalized patients infected with SARS-CoV-2, the virus that causes COVID-19. Here, we identify the spectrum of associated neurological symptoms and diagnoses, define the time course of their development, examine readmission rates and mortality risk post-hospitalization in a multiethnic urban cohort.Methods: We identify the occurrence of new neurological diagnoses among patients with laboratory-confirmed SARS-CoV-2 infection in New York City. A retrospective cohort study was performed of 532 cases (hospitalized patients with new neurological diagnoses within 6 weeks of positive SARS-CoV-2 laboratory results between March 1, 2020 and August 31, 2020). We compare demographic and clinical features of the 532 cases to 532 COVID-19 positive controls without neurological diagnoses in a case-control study with 1 to 1 matching; and examine hospital-related data and outcomes of death and readmission up to 6 months after acute hospitalization in a secondary case-only analysis.Results: Among the 532 cases, the most common new neurological diagnoses included encephalopathy (478, 89.8%), stroke (66, 12.4%), and seizures (38, 7.1%). In the case-control study, cases were more likely than controls to be male (58.6% vs. 52.8%, p=0.05), have baseline neurological comorbidities (36.3% vs. 13.0%, p<0.0001) and be treated in an intensive care unit (ICU) (62.0% vs. 9.6%, p < 0.0001). Of the 394 (74.1%) cases that survived the acute hospitalization, more than half (220/394, 55.8%) were readmitted within 6 months, with a mortality rate of 23.2% during readmission.Conclusion: Many patients hospitalized with SARS-CoV-2 have new neurological diagnoses, with significant morbidity and mortality post-discharge. Further research is needed to define the impact of neurological diagnoses during acute hospitalization on longitudinal post-COVID-19 related symptoms including neurocognitive impairment.

Critical illness and sepsis are commonly associated with subclinical seizures. COVID-19 frequently causes severe critical illness, but the incidence of electrographic seizures in patients with COVID-19 has been reported to be low. This retrospective case series assessed the incidence of and risks for electrographic seizures in patients hospitalized with COVID-19 who underwent continuous video electroencephalography monitoring (cvEEG) between March 1st, 2020 and June 30th, 2020. One hundred and twenty-two patients were initially identified who resulted SARS-CoV-2 nasopharyngeal RT-PCR swab positivity with any electroencephalography order placed in the EMR. Seventy-nine patients met study inclusion criteria: age ≥18 years, &gt;1 h of cvEEG monitoring, and positive SARS-CoV-2 nasopharyngeal swab PCR. Six (8%) of the 79 patients suffered electrographic seizures (ES), three of whom suffered non-convulsive status epilepticus. Acute hyperkinetic movements were the most common reason for cvEEG in patients with ES (84%). None of the patients undergoing cvEEG for persistent coma (29% of all patients) had ES. Focal slowing (67 vs. 10%), sporadic interictal epileptiform discharges (EDs; 33 vs. 6%), and periodic/rhythmic EDs (67 vs. 1%) were proportionally more frequent among patients with electrographic seizures than those without these seizures. While 15% of patients without ES had generalized periodic discharges (GPDs) with triphasic morphology on EEG, none of the patients with ES had this pattern. Further study is required to assess the predictive values of these risk factors on electrographic seizure incidence and subsequent outcomes.

No abstract

No abstract