Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

Abstract

Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.

Neurological complications of COVID-19: from bridesmaid to bride

“…The SARS-CoV-2 virus is a respiratory pathogen and hence complications affecting the brain could be secondary to hypoxia and metabolic derangements. However, the current paper by Studart-Neto et al 1 finds, and other similar descriptions emerging from around the world show that the vast majority of patients have other types of neurological involvement, some of which can be severe 2,3,4,5 . While loss of smell and taste is the most common symptom observed, nearly half of the patients hospitalized have some form of encephalopathy and about a fifth of the patients develop strokes 6,7 .…”

Clinical, cerebrospinal fluid, and neuroimaging findings in COVID-19 encephalopathy: a case series

“…Fifty-five patients were included in the final analysis (Flowchart 1). All patients were also included in a previous study that evaluated reasons for neurology consultation in Hospital das Clínicas [7]. Detailed clinical and ancillary data of patients with encephalopathy were not provided in that report.…”

“…Agitation and confusion occur commonly in patients with acute respiratory distress syndrome in COVID-19 [6]. In a previous series of consecutive COVID-19 patients evaluated by neurologists in a dedicated COVID-19 tertiary referral hospital, encephalopathy was the leading reason for a neurology consultation [7].…”

What can the neurological manifestations of COVID-19 tell us : a meta-analysis

“…Although COVID-19 is typically characterized by respiratory symptoms, numerous clinical studies have shown that patients infected with SARS-COV-2 are associated with acute injuries to external pulmonary organs, including the heart, digestive tract, liver, kidney and nervous system [6][7] .More and more clinical evidence indicates that SARS-COV-2 may invade the central nervous system. A retrospective analysis of 214 patients with COVID-19 found that 78 (36.4%) had nervous system involvement, and 28.2% of them had severe central nervous system injury [8] .Studart-neto A et al retrospectively analyzed 1208 patients with COVID-19 and found that 89 (7.4%) presented neurological manifestations, including encephalopathy (44.4%), stroke (16.7%), epilepsy (9.0%), neuromuscular disease (5.6%), other acute brain injury (3.4%), and other mild non-speci c diseases (11.2%) [9] .Takeshi et al detected SARS-COV-2 RNA in cerebrospinal uid specimens, providing direct evidence for the nerve invasiveness of SARS-COV-2 [10] .There are three main types of COVID-19 nervous system involvement :(1) central nervous system involvement, such as dizziness, headache, disturbance of consciousness, acute cerebrovascular disease, and epilepsy;(2) peripheral nervous system involvement, including anosmia, decreased taste, decreased vision, and neuralgia;(3) skeletal muscle injury [11][12] .COVID -19 possible mechanisms include: nerve injury by angiotensin converting enzyme (ACE2) receptor function, blood and break through the blood brain barrier, through the way such as olfactory nerve attack the nervous system [13][14] .…”