Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients
- PMID: 33016619
- PMCID: PMC7664279
- DOI: 10.1002/acn3.51210
Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients
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.
© 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.
Conflict of interest statement
The authors report no conflict of interest pertaining to this publication.
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Comment in
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Atteintes neurologiques chez les patients Covid-19.Rev Med Suisse. 2020 Dec 16;16(719):2458. Rev Med Suisse. 2020. PMID: 33325665 French. No abstract available.
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Reply to COVID-19 encephalopathy, Bayes rule, and a plea for case-control studies.Ann Clin Transl Neurol. 2021 Mar;8(3):726. doi: 10.1002/acn3.51287. Epub 2021 Jan 29. Ann Clin Transl Neurol. 2021. PMID: 33512080 Free PMC article. No abstract available.
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COVID-19 encephalopathy, Bayes rule, and a plea for case-control studies.Ann Clin Transl Neurol. 2021 Mar;8(3):723-725. doi: 10.1002/acn3.51288. Epub 2021 Jan 29. Ann Clin Transl Neurol. 2021. PMID: 33512092 Free PMC article. No abstract available.
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Reader Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.Neurology. 2021 Mar 16;96(11):550. doi: 10.1212/WNL.0000000000011613. Neurology. 2021. PMID: 33723026 No abstract available.
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Author Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.Neurology. 2021 Mar 16;96(11):551. doi: 10.1212/WNL.0000000000011611. Neurology. 2021. PMID: 33723027 No abstract available.
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