Neurological manifestations in 404 COVID-19 patients in Washington State

Abstract

This hospital was among the first to report cases and deaths of COVID-19 patients in the United States. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most neurological manifestations of COVID-19 have been reported from non-USA health systems for hospitalized patients [1-3]. All patients had laboratory confirmed SARS-CoV-2 infection. Only new onset neurological manifestations were included. Study data were extracted from electronic medical records, and all neurological manifestations were confirmed via chart review by a neurologist and neuropsychologist. The study was approved by institutional review board and ethics committee. Core presenting symptoms were fever, cough, and shortness of breath. Clinical characteristics and admission laboratory measures are summarized in Table 1. Shapiro's test revealed significant deviations from normal distribution. Therefore, non-parametric alternatives to the t test (Wilcox rank sum test and Hodges-Lehmann estimation) were used, at alpha level of 0.05, adjusted for multiple comparisons using the Benjamini-Hochberg method. Female patients younger than 65 years old were more likely to have neurological symptoms; however, the findings were not statistically significant. Asian patients were 2.02 times more likely to have neurological symptoms than

Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians

“…To date, five cohort studies provided a prevalence of neurological manifestations in a total of 2533 COVID-19 patients [2] , [3] , [4] , [5] , [6] ( Table 1 ). This prevalence ranged from 4.3 to 73.0% depending on which symptoms are considered.…”

“…Impaired consciousness was one of the most common neurological symptoms in cohort studies, reported in 1.8 to 21.3% of hospitalized COVID-19 patients [2] , [3] , [4] , [5] , [6] ( Table 1 ), up to 69% in severe patients needing intensive care management [11] . Disorder of consciousness occurred with a mean time of onset of 8 to 9 days in the evolution of COVID-19, and was associated with severe infection, older age, higher creatine kinase levels, lower lymphocyte counts and higher blood urea nitrogen [2] , [3] .…”

“…A reduction in global stroke admission was observed during the COVID-19 outbreak but is not yet fully understood [55] . Acute cerebrovascular diseases were reported in a proportion of 0.7 to 5.8% among hospitalized COVID-19 patients [2] , [3] , [4] , [5] , [6] with predominant acute ischemic stroke (AIS) followed by intracranial hemorrhage (ICH), cerebral venous thrombosis (CVT) and PRES ( Table 1 ).…”

“…Among neurological manifestations, acute cerebrovascular disease represents half of the case reports ( Table 2 ) and half of patients included in the UK-wide surveillance study [7] , but only 1 to 25% in the other cohort studies [2] , [3] , [4] , [5] , [6] , [10] . The causal relationship between SARS-CoV-2 and stroke have not yet been demonstrated but a recent study showed that the risk of stroke was significantly higher with SARS-CoV-2 infection than with influenza infection, after adjustment for vascular risk factors [56] .…”

Altered mental status in 71 deaths due to COVID-19

“…Of the 45 patients discharged, 15 (33%) demonstrated a dysexecutive syndrome consisting of inattention, disorientation and/or poorly organized movements to command [4]. In a review of neurological manifestions in 404 hospitalized COVID-19 patients from the first US hospital with recorded cases, Agarwal et al [5] found neurological findings in 295 of 404 patients (73%). CNS symptoms were seen in 208 patients (52%) with altered mental status (21%) being the most common, followed by headache in 82 (20%), dizziness in 31 (8%), balance difficulties in 20 (5%), stroke in three (1%) and seizure in two.…”