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

Abstract

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.

Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients

“…Nine cohort studies ( n = 13,741 patients) reported data on the incidence of intracranial hemorrhage (ICH) in COVID-19 patients, with the incidence ranging from 0.3 to 1.2% [ 10 , 13 , 16 , 19 – 22 , 26 , 28 ]. The pooled incidence of ICH across these nine studies was 0.7% (95% CI 0.5–0.9), with low levels of inter-study heterogeneity observed ( I 2 = 33.6%, Cochran’s Q = 12.05, p = 0.149) (Fig.…”

Stroke in COVID-19: A systematic review and meta-analysis

“…There was variation in stroke incidence rates among individuals with COVID-19 across the included studies. This may reflect differences in the population studied; highest rates were reported in cohorts of critically ill patients (18,19), and in studies analyzing neurological complications of COVID-19 (20)(21)(22). It may also reflect differences in healthcare system organization, and intensity of neurologic screening.…”

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

“…As of now, five patients with ADEM have been reported after CoV infection; one adolescent with HCoV- [41], [42], [43], [44], [45], [46], [47], [48], [49],. [50], [51], [52], [53], [54], [55], 56), [57], [58], [ [43], [47], [48], [57], [60], [62], [69], [70], [71], [72] 173 NR in all articles. Kong Z et al [72]reported a 53 Y/O F with dizziness as the first presentation of COVID-19.…”

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