Retrospective Multihospital Prevalence Study of COVID-19 Acute Neurological Manifestations

ABSTRACT

Objective: We aim to investigate the prevalence, characteristics and outcomes of COVID-19 patients with neurological manifestations Background: To date, SARS-CoV2 has infected 213 million population worldwide. It is a multisystem disease affecting primarily the respiratory system, but neurological manifestations have been increasingly described in the literature. Design/Methods: Consecutive patients diagnosed with SARS-CoV2 admitted to 5 hospitals in Detroit Medical Center from March 3rd, 2020-May 1st, 2020 were included. Basic demographics and clinical manifestations were included. Relevant laboratory findings and neuroimaging were reported. Results: 413 patients were included in the study. Patients' demographics were as follows mean age-66 years, 212 (51%) male, 346 (87%) African-American. 219(53%) patients had neurological symptoms at presentation, 32 patients presented purely with neurological symptoms. Other symptoms at onset include-respiratory 312(76%), constitutional 250(61%) and gastrointestinal 104(25%). 121(29%) patients were admitted to ICU, mean days from admission to ICU was 3.14 days. Incidence of neurological presentations were as follows Encephalopathy 191(46.25%), myalgia 51(12.35%), headache 27 (6.54%), vertigo 20 (4.84%), hypogeusia 14 (3.39%), anosmia 12 (2.9%), stroke 13(3.14%), seizure 11 (2.9%). For patients with encephalopathy, median GCS at the onset of encephalopathy was 13 with IQR4. 94 (49.21%) of these patients were admitted to ICU;53(27.75%) were without coexisting toxic, metabolic or hypoxic factors contributing to encephalopathy. For patients with stroke, 12 patients presented with acute ischemic stroke, 2 with hemorrhagic conversion and 1 patient had cerebral venous sinus thrombosis. Characteristics of stroke were as follows 8-multiple vascular territory, 11-cryptogenic etiology, 3-concurrent thromboembolic event. Median D-dimer was 5.76mg/LFEU(IQR3.74) and fibrinogen 550mg/dl(IQR 2.1). 2 patients received thrombolysis and 1 underwent thrombectomy. Mortality was 77%, Modified Rankin Scale (MRS)at baseline was 0-2 and all except 1 patient had MRS of 4-6 on discharge. Conclusions: Neurological manifestation is common amongst patients with SARS-CoV-2. Presence of encephalopathy or stroke confers an increased risk of mortality and morbidity.