Neurological Disorders Associated With COVID-19 Hospital Admissions: Experience of a Single Tertiary Healthcare Center

  1. Permesh Singh Dhillon
  2. Robert A. Dineen
  3. Haley Morris
  4. Radu Tanasescu
  5. Esmaeil Nikfekr
  6. Jonathan Evans
  7. Cris S. Constantinescu
  8. Akram A. Hosseini

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Abstract

Background: Early reports have detailed a range of neurological symptoms in patients with the SARS-CoV-2 infection. However, there is a lack of detailed description and incidence of the neurological disorders amongst hospitalized COVID-19 patients. We describe a range of neurological disorders (other than non-specific neurological symptoms), including their clinical, radiological, and laboratory findings, encountered in our cohort of COVID-19 patients admitted to a large tertiary institution.

Methods: We reviewed our prospectively collated database of all adult Neurology referrals, Neurology and Stroke admissions and Neurological multi-disciplinary team meetings for all hospitalized patients with suspected or proven COVID-19 from 17 March 2020 to 31 August 2020.

Results: Twenty-nine of 1,243 COVID-19 inpatients (2.3%) presented with COVID-19-related neurological disorders. The mean age was 68.9 ± 13.5(SD) years, age range of 34–97 years, and there were 16 males. Twenty two patients had confirmed, five were probable and two had suspected COVID-19 infection according to the WHO case classification. Eight patients (27%) required critical care admission. Neurological symptoms at presentation included acute confusion and delirium, seizures, and new focal neurological deficits. Based on the pre-defined neurological phenotype, COVID-19 patients were grouped into four main categories. Sixteen patients had cerebrovascular events (13 with acute ischemic stroke and three had hemorrhagic features), seven patients were found to have inflammatory, non-inflammatory and autoimmune encephalopathy (including two with known Multiple Sclerosis), whilst disorders of movement and peripheral nervous system were diagnosed in three patients each.

Conclusion: Although the exact prevalence and etiology remain unclear, new onset of neurological disorders, in addition to anosmia, is non-sporadic during the acute COVID-19-infection. Longitudinal follow-up of these patients is required to determine the clinical and functional outcome, treatment response and long-term effects of the SARS-CoV-2 infection.

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  1. ScreenIT

    SciScore for 10.1101/2020.11.22.20235184: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was registered with and approved by the East Midlands-Derby Research Ethics Committee (Ref:18/EM/0292, Major amendments) and individual patient consent was waived (15).
    Consent: This study was registered with and approved by the East Midlands-Derby Research Ethics Committee (Ref:18/EM/0292, Major amendments) and individual patient consent was waived (15).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of our study include its lack of pathological evidence to prove causality. Furthermore, we only included hospitalised patients with COVID-19 in our study, thereby potentially underestimating the true incidence of the neurological associations in patients in the community. There were also inherent drawbacks in the sensitivity and specificity of the available RT-PCR swab tests during the study period, which may have underestimated the incidence of COVID-19 in the patient population (32). Although the exact mechanism and possible causality of the SARS-CoV-2 infection associated with each of the presented neurological disorders remains unclear, it is likely that shared pathophysiological mechanisms are responsible for the various neurological manifestations of COVID-19. Our study lends further support to the growing body of evidence, aiding better understanding of the neurological features and optimizing management strategies using an approach guided by the evolution of clinical, laboratory and imaging features. Longitudinal follow-up of these patients is required to determine the long term effects, treatment response and outcome of the SARS-CoV-2 infection.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.3389/fneur.2021.640017
  3. Version published to 10.1101/2020.11.22.20235184v2 on medRxiv
  4. Version published to 10.1101/2020.11.22.20235184v1 on medRxiv