Neurological manifestations as prognostic factors in COVID-19: a retrospective cohort study

Abstract

Background Neurological manifestations are frequent during COVID-19 but have been poorly studied as prognostic markers of COVID-19. Objectives The aim of this study was to assess whether neurological manifestations are associated with a poor prognosis of COVID-19, and which patient and COVID-19 characteristics were associated with encephalopathy. Methods This was a retrospective cohort study and included patients admitted with COVID-19 in four hospitals from Recife, Brazil. Data were collected by reviewing medical records. Results 613 were included; 54.6% were male, the median age was 54 (41-68) years, 26.4% required mechanical ventilation, and 24.1% died. The neurological symptoms presented were: myalgia (25.6%), headache (22%), fatigue (22%), drowsiness (16%), anosmia (14%), disorientation (8.8%), ageusia (7.3%), seizures (2.8%), and dizziness (1.5%). Twelve patients (2%) had strokes (ischemic strokes: 9) and 149 (24.3%), encephalopathy. Older age, a prolonged hospitalization, diabetes mellitus, a previous history of stroke and having epileptic seizures during hospitalization were significantly associated with the occurrence of encephalopathy. Older age, smoking and requiring mechanical ventilation were associated with prolonged hospitalization. Older patients, those requiring mechanical ventilation and those with encephalopathy presented a significantly higher risk, while those who had anosmia presented a significantly lower risk of dying. Conclusions Neurological symptoms are frequent among patients with COVID-19. Encephalopathy was the most frequent neurological complication and was associated with a higher mortality. Those with anosmia had a lower mortality.

Pregnancy and neurologic complications of COVID‐19: A scoping review

“…Encephalopathy may be the predominant disorder in the initial presentation of COVID‐19. 11 , 15 Many patients had no brain imaging findings or presented with PRES or features of hemorrhagic necrotizing encephalopathy. 15 One of the reported cases of pregnant women with COVID‐19 presented with delirium with no evident brain injury.…”

“… 14 , 15 Encephalopathy, Guillain–Barré syndrome (GBS), and stroke are the most common neurologic conditions reported in association with COVID‐19. 8 , 11 , 15 Delirium, as a presenting feature of encephalopathy, and stroke have been associated with severe COVID‐19. 11 , 16 , 17 …”

“… 8 , 11 , 15 Delirium, as a presenting feature of encephalopathy, and stroke have been associated with severe COVID‐19. 11 , 16 , 17 …”

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

“…Of these, anosmia was associated with a nearly 7-fold decrease in the risk of death among more than 11,000 patients with COVID-19 included in a large meta-analysis of 26 studies [ 37 ]. A recent Brazilian retrospective cohort study that included 613 patients with COVID-19 showed that, apart from older age and a requirement for mechanical ventilation, patients with encephalopathy had a significantly higher risk of death, but those with anosmia had a lower risk of dying [ 6 ]. Many other studies confirmed the protective role of another neurological symptom, namely headache, in terms of the risk of death due to SARS-CoV-2 infection [ 21 , 38 , 39 ].…”

“…The COVID-19 pandemic also resulted in the increased incidence of mental health disorders, such as anxiety, depression, and insomnia [ 4 ]. The broad variety of neurological symptoms in the course of SARS-CoV-2 infection ranged from mild manifestations, including myalgia, headache [ 5 ], fatigue, dizziness, and anosmia, to more severe presentations, such as seizures, stroke, and encephalopathy [ 6 ]. Involvement of both the central and peripheral nervous systems was common within the first 14 days of the SARS-CoV-2 infection [ 7 ].…”