CLINICAL PROFILE OF NEUROLOGICAL MANIFESTATIONS OF COVID-19 DURING HOSPITAL STAY: A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.22159/ajpcr.2024v17i12.53450Keywords:
COVID-19, Neurological manifestations, Delirium, StrokeAbstract
Objective: Since its emergence, coronavirus disease-19 (COVID-19), caused by syndrome coronavirus type 2 (SARS-CoV-2), has shown diverse neurological manifestations, including central nervous system (CNS) complications such as strokes, encephalitis, and delirium. In addition, peripheral nervous system conditions such as Guillain–Barré syndrome, and musculoskeletal issues such as myalgia and rhabdomyolysis are also reported in cases of COVID-19. These are linked to direct viral invasion, hypercoagulability, and immune-mediated injury. Our study during the pandemic systematically evaluated these neurological impacts to understand and address long-term morbidity.
Methods: This cross-sectional observational study at a dedicated COVID-19 center in Mumbai evaluated 200 SARS-CoV-2-positive patients for neurological manifestations. Patients were categorized into “Neuro first” and “COVID first” groups based on symptom onset. Comprehensive neurological assessments, laboratory tests, and imaging were conducted. Data were analyzed using SPSS with statistical tests to compare groups, and logistic regression identified factors linked to neurological involvement.
Results: Out of 200 COVID-19 patients, neurological manifestations were seen in 47.5%, with significantly higher proportions in severe cases (Stage IIB/III). Common findings included asymptomatic elevated creatine phosphokinase (CPK) (29.4%), headache (18.9%), stroke (15.8%), dysgeusia (14.7%), and anosmia (10.5%). Neurological involvement was 11.6 times higher in severe cases and significantly associated with lower PaO₂ and elevated CPK levels. Severe CNS complications, such as large vessel occlusion strokes and encephalitis, were exclusive to higher disease severity. Mortality was 7.5% overall, with no significant difference between those with and without neurological symptoms.
Conclusion: Neurological manifestations such as stroke, headache, and dysgeusia were common in COVID-19 patients. There was a significant correlation between neurological manifestations and disease severity as well as elevated CPK levels.
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References
Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020 Mar 19;91(1):157-60. doi: 10.23750/abm.v91i1.9397. PMID: 32191675; PMCID: PMC7569573
Chen Z, Peng Y, Wu X, Pang B, Yang F, Zheng W, et al. Comorbidities and complications of COVID-19 associated with disease severity, progression, and mortality in China with centralized isolation and hospitalization: A systematic review and meta-analysis. Front Public Health. 2022 Aug 16;10:923485. doi: 10.3389/fpubh.2022.923485. PMID: 36052001; PMCID: PMC9424916
Cataldi M, Pignataro G, Taglialatela M. Neurobiology of coronaviruses: Potential relevance for COVID-19. Neurobiol Dis. 2020 Sep;143:105007. doi: 10.1016/j.nbd.2020.105007. PMID: 32622086; PMCID: PMC7329662
Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis. 2021 May;40(5):905-19. doi: 10.1007/s10096-020-04138-6. PMID: 33389262; PMCID: PMC7778857
Tsivgoulis G, Palaiodimou L, Zand R, Lioutas VA, Krogias C, Katsanos AH, et al. COVID-19 and cerebrovascular diseases: A comprehensive overview. Ther Adv Neurol Disord. 2020 Dec 8;13:1756286420978004. doi: 10.1177/1756286420978004. PMID: 33343709; PMCID: PMC7727052
Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Crit Care. 2020 Apr 28;24(1):176. doi: 10.1186/s13054-020- 02882-x. PMID: 32345343; PMCID: PMC7186945
Friedman SA, Charmchi Z, Silver M, Jacoby N, Perk J, Anziska Y. Skeletal muscle manifestations and creatine kinase in COVID-19. Neurohospitalist. 2022 Oct;12(4):597- 606. doi: 10.1177/19418744221105961. PMID: 36147765; PMCID: PMC9160579
Zanza C, Romenskaya T, Manetti AC, Franceschi F, La Russa R, Bertozzi G, et al. Cytokine storm in COVID-19: Immunopathogenesis and therapy. Medicina (Kaunas). 2022 Jan 18;58(2):144. doi: 10.3390/ medicina58020144. PMID: 35208467; PMCID: PMC8876409
Bota SE, McArthur E, Naylor KL, Blake PG, Yau K, Hladunewich MA, et al. Long-term morbidity and mortality of coronavirus disease 2019 in patients receiving maintenance dialysis: Amulticenter population-based cohort study. Kidney360. 2024 Aug 1;5(8):1116-25. doi: 10.34067/ KID.0000000000000490. PMID: 39151048; PMCID: PMC11371337
World Health Organization. Living Guidance for Clinical Management of COVID-19: Living Guidance. World Health Organization; 2021 Available from: https://www.who.int/publications/i/item/WHO-2019- nCoV-clinical-2021-2
Meppiel E, Peiffer-Smadja N, Maury A, Bekri I, Delorme C, Desestret V, et al. contributors to the NeuroCOVID registry. Neurologic manifestations associated with COVID-19: A multicentre registry. Clin Microbiol Infect. 2021;27(3):458-66. doi: 10.1016/j.cmi.2020.11.005, PMID: 33189873.
Romero-Sanchez CM, Diaz-Maroto I, Fernandez-Diaz E, Sánchez- Larsen Á, Layos-Romero A, García-García J, et al. Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Neurology. 2020;95(8):e1060-70. doi: 10.1212/ WNL.00000000000009937
Garg R, Jain R, Sodani A, Chouksey D, Dosi R, Athale S, et al. Neurological symptoms as initial manifestation of Covid-19 - an observational study. Ann Indian Acad Neurol. 2020 Jul- Aug;23(4):482-6. doi: 10.4103/aian.AIAN_560_20. PMID: 33223664; PMCID: PMC7657287
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77(6):683-90. doi: 10.1001/ jamaneurol.2020.1127. PMID: 32275288; PMCID: PMC7149362
Karadas Ö, Öztürk B, Sonkaya AR. A prospective clinical study of detailed neurological manifestations in patients with COVID-19. Neurol Sci. 2020;41(8):1991-5. doi: 10.1007/s10072-020-04547-7
Pinna P, Grewal P, Hall JP, Tavarez T, Dafer RM, Garg R, et al. Neurological manifestations and COVID-19: Experiences from a tertiary care center at the Frontline. J Neurol Sci. 2020 Aug 15;415:116969. doi: 10.1016/j. jns.2020.116969. PMID: 32570113; PMCID: PMC7832569
Nannoni S, de Groot R, Bell S, Markus HS. Stroke in COVID-19: Asystematic review and meta-analysis. Int J Stroke. 2021 Feb;16(2):137- 49. doi: 10.1177/1747493020972922. PMID: 33103610; PMCID: PMC7859578
Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute transverse myelitis (ATM): Clinical review of 43 patients with COVID-19-associated ATM and 3 post-vaccination ATM serious adverse events with the ChAdOx1 nCoV-19 vaccine (AZD1222). Front Immunol. 2021 Apr 26;12:653786. doi: 10.3389/fimmu.2021.653786. PMID: 33981305; PMCID: PMC8107358
Keshavarzi A, Janbabaei G, Kheyrati L, Ghavamabad LH, Asadi- Pooya AA. Seizure is a rare presenting manifestation of COVID-19. Seizure. 2021 Mar;86:16-8. doi: 10.1016/j.seizure.2021.01.009. PMID: 33515905; PMCID: PMC7825948
Frithiof R, Rostami E, Kumlien E, Virhammar J, Fällmar D, Hultström M, et al. Critical illness polyneuropathy, myopathy and neuronal biomarkers in COVID-19 patients: A prospective study. Clin Neurophysiol. 2021 Jul;132(7):1733-40. doi: 10.1016/j. clinph.2021.03.016. PMID: 33875374; PMCID: PMC8012169
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