Clinical features of neurological patients with coronavirus 2019: an observational study of one centre

Abstract

Background. Since the emergence of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) in Wuhan, China, it has been extensively studied by many scientists. Susceptibility to SARS-CoV-2 infection is shown by people of all ages, especially those with different comorbidities. Our goal was to describe the clinical characteristics, treatment, course, and outcome of COVID-19 in patients with pre-existing neurological disorders.Materials and methods. We retrospectively studied 70 patients with COVID-19 and previous neurological diseases who were treated in the Central Clinical Hospital of the Ministry of the Interior and Administration from 16 March to 15 June 2020. Demographic data, symptoms, image data, laboratory results, treatment methods and results, clinical signs and symptoms of patients hospitalised due to CNS diseases with COVID-19 were collected.Results. The average age of hospitalised patients was 72, and the majority (63%) were women (44/70). The most common neurological disease was dementia, which was present in almost a third of patients (30.76%), followed by ischaemic stroke (24.61%). Chest imaging showed the presence of interstitial changes in 47% (33) of patients. Laboratory tests revealed increased total blood cells, increased levels of C-reactive protein, procalcitonin, D-dimers, liver indicator markers and IL-6 in the most severely affected patients. The treatment of patients was focused on monitoring their clinical condition, and supporting respiratory inefficiency with passive oxygen therapy and mechanical ventilation. According to the guidelines of the Hospital Therapeutic Committee, pharmacological treatment (Arechin®, Kaletra®) was introduced in cases without contraindications. In patients with moderate COVID-19, antimalarial or antiviral agents were applied (78%). 30% of our observed patients died during the hospitalisation.Conclusions. We studied a select group of patients (elderly, with comorbidities, and moderate or severe COVID-19 course). Pre-existing neurological disorders were additionally associated with a poorer prognosis and a high fatality rate (30%). Dementia and CNS vascular disorder were the most frequent pre-existing neurological conditions. The neurological symptoms of COVID-19 were various. We observed impaired consciousness, dizziness, headache, nausea, myalgia, psychomotor agitation and slowness, delirium, and psychoses. Further analysis is needed to elucidate the incidence of COVID-19 neurological complications.

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

“…Stroke during COVID-19 was also associated with increased in-hospital mortality in the whole group but not in the prospective cohort, probably due to severe neurological deficit which prevented these patients from filling out the questionnaire. Previous research has shown that chronic neurological comorbidity increases the risk of in-hospital mortality [16,17]. A recent meta-analysis of 18 studies, mostly of retrospective design, revealed that the mortality rate in COVID-19 patients with concomitant stroke was concerning and, especially in relation to ischaemic stroke, higher than would be expected due to stroke itself [18].…”

COVID-19 pandemic year in a sample of Polish myasthenia gravis patients: an observational study

“…Therefore, it can be very challenging to distinguish between these two conditions as well as to diagnose MG exacerbation during a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [6]. Moreover, it has been shown that pre-existing neurological disorders are associated with a worse prognosis and a high COVID-19 fatality rate [7]. The first case of SARS-CoV-2 infection in Poland was confirmed on 4 March 2020.…”

Post-COVID 19 Neurological Syndrome: a fresh challenge in neurological management

“…We thank Zielińska-Turek et al [1] for providing such valuable evidence. However, we would like to make some comments on a recently described entity which poses a challenge in the management of patients with a neurological history or who present with neurological complications during the course of COVID-19.…”

“…We read with great interest the article published recently by Zielińska-Turek et al [1] entitled 'Clinical features of neurological patients with coronavirus 2019: an observational study of one centre' , where the authors investigated a cohort of patients with COVID-19 and previous neurological diseases, finding that most of these patients were elderly, with dementia or a history of stroke, and that these conditions associated with COVID-19 worsened the prognosis and increased the mortality of these patients.…”

“…Noting that the average age of the patients of Zielińska-Turek et al [1] was 72 years, and that they also had comorbidities that have a negative impact on the nervous system such as arterial hypertension, type II diabetes mellitus, or dementia [1], it is necessary to pay attention and perform strict follow-up of these patients, because of the increased probability and severity of developing post-COVID-19 neurological syndrome, manifested through the persistence of certain symptoms, or the presentation of neurological disorders in a short period after the resolution of COVID-19 [4,5].…”