The Common Neurological Presentations and Clinical Outcomes of Coronavirus Disease 2019 in Saudi Arabia.

Background: Neurological manifestations have increasingly become recognized in COVID-19. People from different ethnic backgrounds are experiencing different outcomes related to SARS-CoV-2 infection. Several cohort studies reported the common neurological manifestations and complications associated with COVID-19 disease around the world however, the prevalence of neurological complications associated with SARS-CoV-2 infection in the Arab countries and Saudi Arabia is still unknown. Objective: To study the prevalence, risk factors, and characteristics of the neurological complications associated with COVID-19 and their relationship with clinical outcomes. Methods: We conducted a prospective, single-center, observational, cohort study of consecutive hospitalized adults COVID-19 patients with and without neurological manifestation admitted between March 2020 until the end of December 2020. Data was collected prospectively using electronic medical records; Cases and controls were observed until they either get discharged from the hospital or died. The primary outcomes were death, survival, and survival with sequalae. Results: Among 497 patients with COVID-19, 118 patients (23.7%) had neurological complications, 94 patients (18.9%) had encephalopathy, and 16 patients (3.2%) had cerebrovascular accidents (CVA). Patients with COVID-19-related neurological complications were older and more likely to have a pre-existing neurological disease. The most common neurological syndrome associated with COVID-19 were encephalopathy (18.9%) and headache (13.7%). Pre-existing neurological disease and an elevated neutrophil count were the strongest predictors of developing any neurological complications. Death form COVID-19 was associated with age (OR 1.06, 95% CI 1.02-1.10, P = 0.001), invasive ventilation (OR 37.12, 95% CI 13.36-103.14), COVID-19-related-neurological complications (OR 3.24, 95% CI 1.28-8.21, P = 0.01), and elevated CRP level (OR 1.01, 95% CI 1.00-1.01, P = 0.01). Conclusions: COVID-19 is associated with a wide range of neurological manifestations in people living in Saudi Arabia, with older individuals and those with underlying neurological disorders being most at risk. The presence of neurological complications was associated with increased mortality and poor outcomes.

Normative and Equated Data of the Original and Basic Versions of the Montreal Cognitive Assessment among Community Dwelling Saudi Arabians.

INTRODUCTION: Currently, there are standard and basic versions of the MoCA, the latter designed for those with lower educational achievements. Community-based normative data on these versions of the MoCA from Arabic populations are deficient, and there is little data demonstrating how both scales perform in comparison. We aim to obtain normative performances from both versions and equate the measures of both scales. METHODS: Community-based recruitment of healthy volunteers ≥ 18 years of age. Participants underwent testing with both versions. Demographic data was collected with regard to age, gender, years of education, diabetes, and hypertension. Regression analysis was performed to determine significance of variables, and the circle-arc equating method was used to equate the two scores from each scale. RESULTS: 311 participants were included in the study. The mean (sd) age was 45.8 (15.96), females were 184 (59.16%), and the duration of education was 12.7 (5.67) years. The mean scores on the MoCA-A and MoCA-B were 21.47 (4.53) and 24.37 (4.71) (P < 0.0001), respectively. Multivariate regression showed significance of age and years of education in both versions (both variables with P < 0.0001). Correlation coefficient between the two scales was 0.77 (P < 0.0001). The largest equated difference between both MoCA versions was four points in those scoring from 10-20 on the MoCA-A. CONCLUSION: We present normative data from a large Saudi Arabian community-based sample with two different MoCA tests, and an equating graph is presented to determine the corresponding expected performance between the two scales.

Acute HIV Infection Masquerading as Idiopathic Intracranial Hypertension: A Case Report and Literature Review.

We describe a previously healthy 21-year-old man who presented acutely with signs and symptoms of raised intracranial pressure (ICP). Lumbar puncture yielded an elevated opening pressure and an acellular CSF analysis. Radiological images showed bilateral flattening of the posterior eye globes and an empty sella turcica. His serum HIV antigen/antibody was reactive. We provide a review of published cases that have been labeled as idiopathic intracranial hypertension (IIH) in HIV-infected patients, addressing the appropriateness of labeling such cases as truly idiopathic. We also discuss the importance of a thorough clinical evaluation of raised ICP in those who do not fulfil the typical IIH demographic.