Neurologic manifestations associated with COVID-19 in hospitalized patients

ABSTRACT

Objective: To identify major phenotypes of neurologic manifestations and their prevalence in hospitalized patients infected with severe acute respiratory syndrome corona virus disease 2019 (COVID-19). Background: Emerging evidence suggests COVID-19 presentation is not limited to the respiratory system but may have multi-organ involvement including dysfunctions of the nervous system. However, little is known about the major phenotypes, prevalence, and impact of nervous system involvement on patient outcomes. Design/Methods: We are the coordinating center and part of the GCS-Neuro COVID consortium tier 1 pragmatic study. We prospectively screened 127 consecutive patients admitted to a large academic hospital from 03/22/2020 to 09/05/2020. Adults age ≥ 18 years old admitted to the hospital with suspected or confirmed COVID19 infection were included. Eight patients met exclusion criteria of severe pre-existing baseline neurologic dysfunction such as coma or vegetative state that limit detection of new or worsening neurologic symptoms. Results: Of the total cohort of 119 patients (mean age 63.4 years, 48% women), 73 (61.3%) exhibited new/worsening neurologic symptoms. The most common phenotype was acute encephalopathy (44%), followed by headache (40%), abnormal smell/taste (23%), and new movement abnormalities (21%). Other neurologic manifestations included clinical or electrographic seizures (10%), coma (4%), and intracerebral hemorrhage (3%). Neurologic symptoms began an average of 6.2 days after respiratory symptoms (range 0 to 48), although 2 patients developed neurologic symptoms before respiratory symptoms. COVID-19 patients with neurologic symptoms were less likely to have a favorable outcome at discharge (24.6%) with mRS (0-1) compared to those without neurological symptoms (61.9%). Conclusions: Neurologic manifestations in patients infected with COVID-19 are prevalent and have significant impact on patient outcomes at acute hospital discharge in this single-center study. Further studies are underway to better characterize neurologic symptoms as well as follow-up to determine the long-term impact of COVID-19 on patient outcome and recovery.