Eighty-two percent of hospitalized COVID-19 patients showed neurological symptoms

A retrospective study in the Chicago region shows that more than 80% of hospitalized COVID-19 patients showed neurological symptoms during the course of their illness.

Neurological symptoms were present at the onset of COVID-19 in 42.2% of 509 consecutively admitted COVID-19 patients, at admission in 62.7%, and at any time during the course of the disease in 82.3%, Dr. Igor Koralnik of Northwestern Medicine, Chicago. Reported.And colleagues Annual Report of Clinical Neurology and Translation Neurology..

Myalgia (44.8%), headache (37.7%), encephalopathy (31.8%), and dizziness (29.7%) are the most frequent neurological symptoms, followed by dysgeusia (15.9%) and anosmia (11.4). %) Followed.

Patients with neurological symptoms were younger than those without symptoms. Most patients with neurological symptoms had good functional outcomes at discharge, but encephalopathy (which affected nearly one in three patients) was independent of the severity of respiratory illness. Was associated with increased morbidity and mortality.

“This is the first study in the United States on the prevalence of neurological symptoms in a large population of inpatients,” Koralnik said. Today’s MedPage. Only two other papers have been published that describe the prevalence of neurological symptoms in hospitalized COVID-19 patients. China,other Spain..

Neurological complications of COVID-19 are frequent and often long-lasting, but have not received much attention yet, said Avindra Nath, Senior Researcher of Neurological Disorders and Stroke, NIH National Institute of Neurological Disorders and Stroke. MD states. I was involved in the research.

“It is not unexpected that the most ill patients will have the most neurological complications, but it is surprising that these symptoms are common in young people and are independent of the severity of respiratory involvement. “Nath said. Today’s MedPage.

He pointed out that the retrospective nature of this study may mean that the frequency of neurological symptoms is underreported.

Koralnik et al. Retrospectively analyzed the first 509 consecutive patients admitted to the Northwestern Medicine Healthcare system with COVID-19 between March 5 and April 6. The Northwestern Medicine system consists of one academic medical center in the Chicago area and nine other hospitals. ..

The diagnosis of COVID-19 was confirmed by the SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) assay. Encephalopathy was identified by reports of altered mental status or decreased levels of consciousness, a doctor’s diagnosis of encephalopathy or delirium encephalopathy syndrome, or a positive result. How to evaluate confusion Evaluation.

Functional outcomes at discharge were based on a modified Rankin scale (Mrs), A score of 0-2 means that the patient can take care of his or her things without assistance, and a 6-point disability scale where 6 represents death.

Patients averaged 58.5 years and 55.2% were male. 134 patients (26.3%) had severe COVID-19 requiring mechanical ventilation. In total, 419 of the 509 patients showed neurological symptoms at any time during the course of their illness. Independent risk factors for developing neurological symptoms are severe COVID-19 (OR 4.02, 95% CI 2.04–8.89, P<0.001) and younger ages (OR 0.982, 95% CI 0.968–0.996, P= 0.014).

Strokes, movement disorders, movement and sensory disorders, ataxia, and seizures were rare (0.2-1.4% of patients, respectively). Overall, 71.1% of hospitalized COVID-19 patients with neurological symptoms were discharged with an mRS score of 0-2.

Hospitalized COVID-19 patients with encephalopathy were older than those who did not (66 vs. 55 years, P<0.001), the time from the onset of COVID to hospitalization was short (6 days vs. 7 days, P= 0.014), likely to be male, with a history of neuropathy, cancer, cerebrovascular disease, chronic kidney disease, diabetes, dyslipidemia, heart failure, hypertension, smoking on assessment without multivariate adjustment Was expensive.

“Triggers are likely to be multifactorial, including systemic disease (multiple organ failure, coagulopathy, inflammation), direct viral infection of the brain, or post-infection autoimmune mechanisms,” Coralnick said. ..

The median length of stay for patients with encephalopathy was 17 days, while the median length of stay for patients without encephalopathy was 5 days. At discharge, 32.1% of patients with encephalopathy had an mRS score of 0-2, compared with 89.3% of patients who did not develop encephalopathy.

Encephalopathy was independently associated with worse functional outcomes (OR 0.22, 95% CI 0.11–0.42, P<0.001) and higher mortality within 30 days of admission (21.7% vs 3.2%, P<0.001).

Overall, there was no significant difference in the severity of COVID-19 between patients at the Academic Medical Center and patients at 9 other hospitals, but patients at the Academic Center had better functional outcomes and lower 30-day mortality. Showed the rate.

“There are concerns that patient outcomes were different in different hospitals,” Nath said. “The author attributed this to the difference in the quality of care provided. This means that inpatients require a high level of care that is not available in most places, our healthcare system. Points out an important vulnerability in. “

The study had several limitations, including its retrospective nature and the fact that less than 6% of patients were evaluated by a neurologist or neurosurgeon. Researchers said access to brain CT or MRI was restricted due to strict infection control precautions.