Neurologic Complications Common in Patients With COVID-19

June 10, 2020

The study confirmed previous study findings that indicated potential severe conditions such as stroke or inflammatory diseases can appear in later stages of COVID-19, including during recovery.

Data from a systematic review of patients diagnosed with COVID-19 admitted to a hospital in a Spanish population during March 2020 revealed that neurological manifestations were common, with more than half of the patients presenting some form of neurological symptoms.1

Of 841 patients hospitalized with COVID-19 (mean age, 66.4 years; 56.2% men), 57.4% (n = 483) developed a neurological symptom. At the early stages of infection, nonspecific symptoms such as myalgias (17.2%), headache (14.1%), and dizziness (6.1%) were the most reported.

A total of 329 (39.1%) suffered severe COVID-19 infection, 77 (9.16%) were admitted to the intensive care unit (ICU), and 197 (23.4%) died during the course of their hospital admissions. Neurological complications were considered to be the fundamental cause of patient death in 8 cases (4.1%).

Conducted by Carlos Manuel Romero-Sanchez, MD, of Complejo Hospitalario Universitario de Albacete in Spain, and colleagues, the study’s patients had demographic data such as age, sex, previous comorbidities (hypertension, diabetes, dyslipidemia, smoking habit, obesity, heart disease, chronic kidney disease [CKD], immunosuppression, cancer, neurological diseases) and relevant previous treatments were recorded.

Neurological manifestations were categorized into nonspecific symptoms such as the aforementioned symptoms of headache, dizziness, and myalgia. Other categories included neuropsychiatric disorders (insomnia depression, anxiety or psychosis), central nervous system (CNS) disorders (direct viral infection, disorders of consciousness, seizures and stroke), and peripheral nervous system (PNS) disorders (cranial neuropathies, anosmia/dysgeusia, peripheral neuropathy), as well as myopathy and demyelinating events.

More frequent, but less severe, cases of anosmia and dysgeusia occurred in 4.9% and 6.2% of patients, respectively, and tended to occur early, with 60% of patients experiencing them as the first clinician manifestation.

The research noted disorders of consciousness occurred in 19.6% of patients, oftentimes in older patients and in severe and advanced COVID-19 stages. Less frequent neurologic manifestations such as myopathy, dysautonomia, cerebrovascular diseases, seizures and movement disorders occurred in 3.1%, 2.5%, 1.7%, 0.7%, and 0.7% of patients, respectively. Encephalitis, Guillain-Barre syndrome, and optic neuritis also were reported in 1 patient case each.

Romero-Sanchez and authors concluded that with these results, clinicians should maintain close neurological surveillance for prompt recognition of these complications. Additional studies are needed to understand the mechanisms and emerging consequences of SARS-CoV-2 neurological involvement.

The study authors went on to write, “Since the global emergency is expected to persist for some time, we encourage first-line doctors to be aware of potential neurological symptoms. We recommend that patients with altered levels of consciousness or confusion should be evaluated by a neurologist, especially in the absence of hypoxemia or marked metabolic alterations.”

The results of this study mirror previous studies conducted on the similar matter. In 1 of the first multi-case studies of neurologic manifestations of COVID-19, researchers found central and peripheral nervous system (PNS) and skeletal muscular manifestations common. The data extracted from electronic health records of patients treated at the Union Hospital of Huazhong University of Science and Technology in Wuhan, China, showed that 36.4% (n = 78) had neurologic manifestations, which were categorized similarly to the trial conducted by Romero-Sanchez.2

More specifically, of those 78 patients, 53 were categorized as having central nervous system, 19 as PNS, and 23 as skeletal muscular manifestations. Researchers also noted that Other nervous system manifestations included acute cerebrovascular disease (5.7%), with 4 patients experiencing ischemic stroke and 1 with cerebral hemorrhage (P = .03), impaired consciousness (P <.001), and skeletal muscular injury (P <.001).

As well, NeurologyLive recently caught up with Jennifer Frontera, MD, professor of neurology, NYU Langone Grossman School of Medicine, to discuss her frontline experience during the COVID-19 pandemic and how she has provided care for patients with the virus who have preexisting neurologic conditions. Listen to her insights below.

LISTEN MORE: Podcast: Neurology and COVID-19: Perspectives From the Front Line

REFERENCES

1. Romero-Sanchez CM, Diaz-Maroto I, Fernandez-Diaz E, et al. Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Neurology. Published online June 1, 2020. doi: 10.1212/WNL.00000000000009937.

2. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. Published online April 10, 2020. doi:10.1001/jamaneurol.2020.1127