Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients

Ann Clin Transl Neurol. 2020 Nov;7(11):2221-2230. doi: 10.1002/acn3.51210. Epub 2020 Oct 5.

Abstract

Objective: Covid-19 can involve multiple organs including the nervous system. We sought to characterize the neurologic manifestations, their risk factors, and associated outcomes in hospitalized patients with Covid-19.

Methods: We examined neurologic manifestations in 509 consecutive patients admitted with confirmed Covid-19 within a hospital network in Chicago, Illinois. We compared the severity of Covid-19 and outcomes in patients with and without neurologic manifestations. We also identified independent predictors of any neurologic manifestations, encephalopathy, and functional outcome using binary logistic regression.

Results: Neurologic manifestations were present at Covid-19 onset in 215 (42.2%), at hospitalization in 319 (62.7%), and at any time during the disease course in 419 patients (82.3%). The most frequent neurologic manifestations were myalgias (44.8%), headaches (37.7%), encephalopathy (31.8%), dizziness (29.7%), dysgeusia (15.9%), and anosmia (11.4%). Strokes, movement disorders, motor and sensory deficits, ataxia, and seizures were uncommon (0.2 to 1.4% of patients each). Severe respiratory disease requiring mechanical ventilation occurred in 134 patients (26.3%). Independent risk factors for developing any neurologic manifestation were severe Covid-19 (OR 4.02; 95% CI 2.04-8.89; P < 0.001) and younger age (OR 0.982; 95% CI 0.968-0.996; P = 0.014). Of all patients, 362 (71.1%) had a favorable functional outcome at discharge (modified Rankin Scale 0-2). However, encephalopathy was independently associated with worse functional outcome (OR 0.22; 95% CI 0.11-0.42; P < 0.001) and higher mortality within 30 days of hospitalization (35 [21.7%] vs. 11 [3.2%] patients; P < 0.001).

Interpretation: Neurologic manifestations occur in most hospitalized Covid-19 patients. Encephalopathy was associated with increased morbidity and mortality, independent of respiratory disease severity.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ataxia / physiopathology
  • Betacoronavirus
  • Brain Diseases / physiopathology*
  • COVID-19
  • Chicago
  • Coronavirus Infections / mortality
  • Coronavirus Infections / physiopathology*
  • Coronavirus Infections / therapy
  • Dizziness / physiopathology*
  • Dysgeusia / physiopathology*
  • Female
  • Headache / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Mortality
  • Movement Disorders / physiopathology
  • Myalgia / physiopathology*
  • Olfaction Disorders / physiopathology*
  • Pandemics
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / physiopathology*
  • Pneumonia, Viral / therapy
  • Prognosis
  • Respiration, Artificial
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Seizures / physiopathology
  • Severity of Illness Index
  • Stroke / physiopathology