Neuro-COVID in the northern Portuguese population

ABSTRACT

Background and aims: COVID-19 related acute neurological phenotypes have been reported in over 30% of hospitalized patients. However, multicentric studies providing a population-based overview are still lacking. Methods: We conducted a retrospective multicentric study in five hospitals in Northern Portugal, between March 1st and June 30th 2020. Patient e-records were systematically revised using a standardized form to identify neurological manifestations stratified by type and severity. Results: From a total of 13,144 persons diagnosed with COVID-19 in the northern region, 2,795 (21.3%) required hospitalization. We reviewed a sample of 1,261 (45.1%) hospitalized patients and found a rate of 362 neurological manifestations per 1000 admitted COVID-19 patients, estimating a total of 1009 hospitalized patients with a neurological manifestation in the Northern Region. Patients with neurologic manifestations were younger (p=0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%) and impairment of consciousness (9.7%). We observed a rate of 7.8 severe neurological events per every 1000 COVID-19 infected patients, including stroke, seizures, Guillain-Barre syndrome and myelopathy. The fatality among patients with neurological manifestations was 19.8%, and 15.6% had a modified Rankin Scale of 4-5 at hospital discharge. Conclusion: We characterized the population of hospitalized COVID-19 patients from the northern region of Portugal and found that neurological symptoms are common and associated with a high degree of disability. CNS involvement with criteria for in-hospital admission was observed in a significant proportion of patients. Neurology support is highly relevant in the multidisciplinary care of COVID-19 patients.