Neurological manifestations in hospitalized patients with Coronavirus disease (COVID-19)

Abstract

Background: SARS-CoV-2 virus-related neurological manifestations are being reported more and more frequently in the scientific literature. Aim: To investigate the neurological findings in hospitalized patients with Coronavirus disease 2019 (COVID-19). Materials and Methods: We conducted a single-center prospective observational study of consecutive adult patients with COVID-19, supported with laboratory tests who were admitted from June 27 to July 27, 2021 at an isolation center functioning as a public acute-care hospital during the COVID-19 pandemic in Ulaanbaatar, the capital city of Mongolia. Detailed neurological examinations and evaluations of all patients were performed. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the “Neuro first” group had neurological manifestations upon initial assessment, and the “COVID-19 first” group developed neurological symptoms greater than 24 h after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms and diagnoses of both groups were analyzed. Statistical analysis was performed to compare the two groups. Results: Of 113 patients with COVID-19 hospitalized during study period, neurological findings were present in 86 (76.1%) patients. The most common neurological manifestations were headache (56.3%), hypogeusia or ageusia (29.2%), hyposmia or anosmia (20.4%), myalgia (13.3%), dizziness (6.2%), neuralgia (4.4%) and ataxia (3.5%). The “COVID-19 first” group had more evidence of neurologic disturbances with a more severe disease course than “Neuro first” group (88.6% vs 59.5%, p 0.025). Presence of at least 1 neurological symptom was indepently associated with fever, dyspnea, cough, nasal congestion, or diarrhea, but not with comorbid condition (p<0.05). Conclusions: Neurologic manifestations of COVID-19 are variable and can occur prior to the diagnosis of or as a complication of the viral infection. Headache, hypogeusia or ageusia, hyposmia or anosmia and myalgia were common seen neurological manifestations in this disease. Despite similar baseline comorbidities and demographics, the COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses.