Frequency and burden of neurological manifestations in hospitalized patients with COVID-19: findings from a large Brazilian cohort

Abstract Background Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection in the Brazilian population and its association with patient outcomes, such as in-hospital mortality. Methods This study is part of the Brazilian COVID-19 Registry, a multicentric COVID-19 cohort, including data from 37 Brazilian hospitals. For the analysis, patients were grouped according to the presence of self-reported vs. clinically-diagnosed neurological manifestations and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital, and whether or not patients ha neurological underlying disease. Results From 7,232 hospitalized patients with COVID-19, 27.8% presented self-reported neurological manifestations, 9.9% were diagnosed with a clinically-defined neurological syndrome and 1.2% did not show any neurological symptoms. In patients with self-reported symptoms, the most common ones were headache (19.3%), ageusia (10.4%) and anosmia (7.4%). Meanwhile, in the group with clinically-defined neurological syndromes, acute encephalopathy was the most common diagnosis (10.5%), followed by coma (0.6%1) and seizures (0.4%). Men and younger patients were more likely to self-report neurological symptoms, while women and older patients were more likely to develop a neurological syndrome. Patients with clinically-defined neurological syndromes presented a higher prevalence of comorbidities, as well as lower oxygen saturation and blood pressure at hospital admission. In the paired analysis, it was observed that patients with clinically-defined neurological syndromes were more likely to require ICU admission (46.9 vs. 37.9%), mechanical ventilation (33.4 vs. 28.2%), to develop acute heart failure (5.1 vs. 3.0%, p=0.037) and to die (40.7 vs. 32.3%, p<0.001) when compared to controls. Conclusion Neurological manifestations are an important cause of morbidity in COVID-19 patients. More specifically, patients with clinically defined neurological syndromes presented a poorer prognosis for the disease when compared to matched controls.

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Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study

10.1101/2020.02.22.20026500 ◽

2020 ◽

Cited By ~ 112

Author(s):

Ling Mao ◽

Mengdie Wang ◽

Shengcai Chen ◽

Quanwei He ◽

Jiang Chang ◽

...

Keyword(s):

Skeletal Muscle ◽

Nervous System ◽

Case Series ◽

Cerebrovascular Diseases ◽

Hospitalized Patients ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Impaired Consciousness ◽

Retrospective Case ◽

Neurologic Symptoms

ABSTRACTOBJECTIVETo study the neurological manifestations of patients with coronavirus disease 2019 (COVID-19).DESIGNRetrospective case seriesSETTINGThree designated COVID-19 care hospitals of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China.PARTICIPANTSTwo hundred fourteen hospitalized patients with laboratory confirmed diagnosis of severe acute respiratory syndrome from coronavirus 2 (SARS-CoV-2) infection. Data were collected from 16 January 2020 to 19 February 2020.MAIN OUTCOME MEASURESClinical data were extracted from electronic medical records and reviewed by a trained team of physicians. Neurological symptoms fall into three categories: central nervous system (CNS) symptoms or diseases (headache, dizziness, impaired consciousness, ataxia, acute cerebrovascular disease, and epilepsy), peripheral nervous system (PNS) symptoms (hypogeusia, hyposmia, hypopsia, and neuralgia), and skeletal muscular symptoms. Data of all neurological symptoms were checked by two trained neurologists.RESULTSOf 214 patients studied, 88 (41.1%) were severe and 126 (58.9%) were non-severe patients. Compared with non-severe patients, severe patients were older (58.7 ± 15.0 years vs 48.9 ± 14.7 years), had more underlying disorders (42 [47.7%] vs 41 [32.5%]), especially hypertension (32 [36.4%] vs 19 [15.1%]), and showed less typical symptoms such as fever (40 [45.5%] vs 92 [73%]) and cough (30 [34.1%] vs 77 [61.1%]). Seventy-eight (36.4%) patients had neurologic manifestations. More severe patients were likely to have neurologic symptoms (40 [45.5%] vs 38 [30.2%]), such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]) and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]).CONCLUSIONCompared with non-severe patients with COVID-19, severe patients commonly had neurologic symptoms manifested as acute cerebrovascular diseases, consciousness impairment and skeletal muscle symptoms.

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Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

Journal of Neurology ◽

10.1007/s00415-021-10406-y ◽

2021 ◽

Author(s):

Biyan Nathanael Harapan ◽

Hyeon Joo Yoo

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Case Reports ◽

Case Series ◽

Altered Mental Status ◽

Neurological Complications ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Fisher Syndrome ◽

Novel Coronavirus ◽

The Impact

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and was first identified in Wuhan, China in December 2019. It is evident that the COVID-19 pandemic has become a challenging world issue. Although most COVID-19 patients primarily develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with COVID-19 have been observed. In this narrative review, we elaborate on proposed neurotropic mechanisms and various neurological symptoms, manifestations, and complications of COVID-19 reported in the present literature. For this purpose, a review of all current published literature (studies, case reports, case series, reviews, editorials, and other articles) was conducted and neurological sequelae of COVID-19 were summarized. Essential and common neurological symptoms including gustatory and olfactory dysfunctions, myalgia, headache, altered mental status, confusion, delirium, and dizziness are presented separately in sections. Moreover, neurological manifestations and complications that are of great concern such as stroke, cerebral (sinus) venous thrombosis, seizures, meningoencephalitis, Guillain–Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome (PRES) are also addressed systematically. Future studies that examine the impact of neurological symptoms and manifestations on the course of the disease are needed to further clarify and assess the link between neurological complications and the clinical outcome of patients with COVID-19. To limit long-term consequences, it is crucial that healthcare professionals can early detect possible neurological symptoms and are well versed in the increasingly common neurological manifestations and complications of COVID-19.

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CNS and COVID-19: Neurological symptoms of hospitalized patients with coronavirus in Iraq: A surveying case sequences study

Research Journal of Pharmacy and Technology ◽

10.5958/0974-360x.2020.01094.x ◽

2020 ◽

Vol 13 (12) ◽

pp. 6291-6294

Author(s):

Abbas Kinbar Kuser ◽

Sagban Marja Tarar ◽

Omar Mansib Kassid ◽

Nael Hussein Zayer

Keyword(s):

Hospitalized Patients ◽

Neurological Symptoms

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Validation of the Spanish Version of the Pain Assessment in Advanced Dementia Scale (PAINAD-Sp) in Hospitalized Patients with Neurologic Disorders and Oncologic Patients Unable to Self-Report Their Pain

Pain Management Nursing ◽

10.1016/j.pmn.2018.08.004 ◽

2019 ◽

Vol 20 (4) ◽

pp. 323-330 ◽

Cited By ~ 1

Author(s):

Lucia Muñoz-Narbona ◽

Sandra Cabrera-Jaime ◽

Teresa Lluch-Canut ◽

Natalia Pérez de la Ossa ◽

Jesús Álvarez Ballano ◽

...

Keyword(s):

Pain Assessment ◽

Hospitalized Patients ◽

Self Report ◽

Spanish Version ◽

Advanced Dementia ◽

Neurologic Disorders ◽

Oncologic Patients

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Atypical Manifestation of Polyneuropathy in Covid-19

10.5327/1516-3180.312 ◽

2021 ◽

Author(s):

Nayara de Lima Froio ◽

Ana Luisa Rosas Sarmento ◽

Sonia Maria Cesar de Azevedo Silva ◽

Lilia Azzi Collet da Rocha Camargo

Keyword(s):

Case Report ◽

Physical Therapy ◽

Sore Throat ◽

Neurological Symptoms ◽

Lower Limbs ◽

Neurological Manifestations ◽

Sensory Motor ◽

Hands And Feet ◽

Atypical Manifestation

Context: Neurological manifestations of Sars-CoV-2 are progressively emerging. Cases of Guillain-Barré syndrome and its variants, with onset about 5-10 days after influenza symptoms, have been described. This paper reports a case of polyneuropathy with onset 90 days after a sore throat episode and persistence of IgM positivity in serology for Sars- Cov-2. We aim to raise awareness of this possibility. Case Report: A 56-year-old male, hypertensive, presented with sore throat on April 21, 2020. Serology for Covid-19 was performed with positive IgM. There was complete improvement of the symptom. At the end of July, he started a symmetrical paresthesia in the feet with ascension to the knees and, on August 20, paresthesia in the hands too. So, he went to IAMSPE (SP) and tactile and painful hypoesthesia in hands and feet, hypopalesthesia in lower limbs, a fall in the lower limbs upon Mingazzini’s maneuver, global hyporeflexia and talon gait were found. Just the following tests were changed: second Covid-19 serology IgM and IgG positives; ENMG: sensory motor polyneuropathy, primarily axonal, with signs of chronicity and without signs of acute denervation in the current. Started gabapentin and physical therapy. Patient still has paresthesia in hands and feet, but with partial improvement. Conclusion: This case alerts to neurological symptoms of Covid-19 in the medium and long term.

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Neurological manifestations associated with SARS-CoV-2 infection: a narrative review

10.5327/1516-3180.442 ◽

2021 ◽

Author(s):

Poliana Rafaela dos Santos Araújo ◽

Kauan Alves Sousa Madruga ◽

Bruna Alves Rocha ◽

Lucas Oliveira Braga

Keyword(s):

Nervous System ◽

Meta Analysis ◽

Neurological Complications ◽

Neurological Symptoms ◽

Narrative Review ◽

Common Symptom ◽

Neurological Manifestations ◽

Cns Involvement ◽

Pubmed Database ◽

Critical Patients

Background: Coronavirus disease (COVID-19), once identified, soon spread globally, becoming a pandemic. Although patients present mainly with respiratory complaints, several neurological symptoms have been reported. Symptoms range from headache and nonspecific dizziness to seizures and cerebrovascular disease (CVD). It has also been shown that the severity of the infection is directly proportional to the development of neurological symptoms, especially CVD and changes in mental status. Objective: The present study aims to briefly review the neurological manifestations of COVID-19 and discuss the pathogenic mechanisms of Central Nervous System (CNS) involvement. Methods: This is an exploratory narrative review with a descriptive approach, consisting of an active search for scientific articles in the PubMed database. The descriptors “coronavirus infections”, “COVID-19” and “Nervous system” were used, with the Boolean operators “OR” and “AND”. Eighteen articles of systematic review and meta-analysis were included. Results: CNS manifestations included, among others: encephalitis, encephalopathy, consciousness decrease, headache, dizziness, acute myelitis, and stroke. As for the peripheral nervous system, skeletal muscle damage, chemosensory dysfunction, and Guillain-Barré syndrome were observed, with hyposmia being the most common symptom. CNS involvement may be related to a worse prognosis. Conclusion: The clinical involvement of the nervous system in COVID-19 is not uncommon, and can result in several neurological complications, especially in the most critical patients. The pathophysiological mechanisms of these events still need further investigation. In the meantime, physicians should value extra-respiratory symptoms ranging from hyposmia, to potentially fatal manifestations, such as stroke and encephalopathy.

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Argentine Registry of neurological manifestations due to coronavirus-19 (COVID-19)

10.1101/2021.03.19.21253558 ◽

2021 ◽

Author(s):

Mariana Bendersky ◽

Lucas Alessandro ◽

Franco Appiani ◽

Brenda Borrego Guerrero ◽

Patricia Cairola ◽

...

Keyword(s):

Demographic Variables ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Cns Involvement ◽

Term Care ◽

Cerebrovascular Complications ◽

Guillain Barré ◽

Neurological Pathology ◽

Degree Of Severity

COVID-19 disease has spread around the world since December 2019. Neurological symptoms are part of its clinical spectrum. Objective: To know the neurological manifestations in patients infected by COVID-19 in Argentina. Methods: Multicenter study conducted in adults, from May 2020 to January 2021, with confirmed COVID-19 and neurological symptoms. Demographic variables, existence of systemic or neurological comorbidities, the form of onset of the infection, alteration in complementary studies and the degree of severity of neurological symptoms were recorded. Results: 817 patients from all over the country were included, 52% male, mean age 38 years, most of them without comorbidities or previous neurological pathology. The first symptom of the infection was neurological in 56.2% of the cases, predominantly headache (69%), then anosmia / ageusia (66%). Myalgias (52%), allodynia / hyperalgesia (18%), and asthenia (6%) were also reported. 3.2% showed diffuse CNS involvement such as encephalopathy or seizures. 1.7% had cerebrovascular complications. Sleep disorders were observed in 3.2%. 6 patients were reported with Guillain Barre (GBS), peripheral neuropathy (3.4%), tongue paresthesia (0.6%), hearing loss (0.4%), plexopathy (0.3%). The severity of neurological symptoms was correlated with age and the existence of comorbidities. Conclusions: Our results, similar to those of other countries, show two types of neurological symptoms associated with COVID-19: some potentially disabling or fatal such as GBS or encephalitis, and others less devastating, but more frequent such as headache or anosmia that demand increasingly long-term care.

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Pharmacopalliation of Pain

Surgical Palliative Care ◽

10.1093/med/9780190858360.003.0021 ◽

2019 ◽

pp. 250-265

Author(s):

James B. Ray

Keyword(s):

Adverse Effect ◽

Palliative Care ◽

Common Factors ◽

Underlying Disease ◽

Self Report ◽

Protective Mechanism ◽

Effective Management ◽

Care Needs ◽

Spiritual Impact ◽

Palliative Care Needs

Pain is one of the most common symptoms that a surgeon may encounter in their patients with palliative care needs. Pain no longer serves an adaptive, protective mechanism but one that is maladaptive and has no redeeming purpose except to add to the patient’s suffering. Effective management requires the surgeon to consider the bio-psychosocial-spiritual impact of the underlying disease when assessing the patient’s self-report of pain. This chapter is a primer and provides an overview of the most common factors that a surgeon may want to consider in providing primary pharmacopalliation of pain, including analgesic selection and adverse effect management.

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Assessment of neurological manifestations in hospitalized patients with COVID‐19

European Journal of Neurology ◽

10.1111/ene.14444 ◽

2020 ◽

Vol 27 (11) ◽

pp. 2322-2328 ◽

Cited By ~ 5

Author(s):

M. Luigetti ◽

R. Iorio ◽

A. R. Bentivoglio ◽

L. Tricoli ◽

V. Riso ◽

...

Keyword(s):

Hospitalized Patients ◽

Neurological Manifestations

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The Spanish Gaucher Registry. An Observatoire To Detect Neurological Manifestations in Patients and Relatives.

Blood ◽

10.1182/blood.v108.11.3850.3850 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3850-3850

Author(s):

Pilar Giraldo ◽

Pilar Alfonso ◽

Paz Latre ◽

Angeles M. Fernandez-Galan ◽

Dora Alonso ◽

...

Keyword(s):

Essential Tremor ◽

Image Data ◽

Epidemiological Survey ◽

Correlation Study ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Non Profit ◽

Rare Mutations ◽

Pearson Coefficient ◽

Neurological Exam

Abstract Background: The Spanish Gaucher Foundation (FEETEG) is an independent and non-profit organization that keeps the Spanish Gaucher Registry (SGR) established in 1993. This SGR contains demographic, genetic, clinical, analytical and image data from a cohort of 306 Gaucher Disease (GD) patients (269 GD1, 22 GD2, 16 GD3), and 751 relatives. The SGR is a useful tool to perform epidemiological-genetic studies and analyse associated comorbilities. Patients and Methods: From January to July 2006 an epidemiological survey to physicians and to the patients through GD Associations was conducted to ascertain the incidence of neurological symptoms in patients and their relatives as well as analyse genotype-phenotype relationship. The statistical analysis was performed in a SPSS 12.0 database using descriptive parameters, ANOVA, t-test and correlation study including Pearson coefficient. Results: Twenty-four (38.7%) out of 62 GD1 patient respondents from 56 families have neurological symptoms, 8 (12.5%) tremor, 8 (12.5%) uncoordinated movements, 11 (17.7%) concentration defects, 3 (4.8%) strabismus and 8 (12.5%) deafness, 3 (4.8%) Parkinson Disease (PD). Twenty-one out of 56 families have one or more relatives with neurological manifestations. There were 29(8.6%) out of 336 relatives with neurological symptoms:13 (3.8%) PD, 5 (1.5%) epilepsy, 6 (1.8%) essential tremor, 5 (1.5%) others. Subjects with PD were carriers of mutations:: S364R, G202R, V398I, R47X, L336P, L444P, G195W, recNci and insertion alleles. In families with epilepsy the predominant carrier mutations were: L444P, G195W, R130W and in essential tremor: L444P. Comments: There is a high incidence of neurological symptoms between GD1 patients and carriers. These manifestations appear frequently in carriers of rare mutations. It is very recommendable to perform a systematic neurological exam in GD1 patients and in carriers with risk mutations.

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