Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

ABSTRACT Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.

摘要
背景：超过三分之一的新型冠状病毒肺炎（Corona Virus Disease 2019, COVID-19）患者会出现从嗅觉丧失到脑卒中、脑病等多种神经系统症状。此外，既往存在神经系统疾病的患者可能需要特殊治疗，且预后更差。尽管如此，神经内科医师在COVID-19诊疗中的作用大概率未得到充分重视。
目的：本研究旨在报告某COVID-19定点医院中，内科医师与重症医学科医师申请神经内科会诊的原因。
方法：本回顾性研究于巴西圣保罗大学医学院附属医院（Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo）开展，该医院为拥有900张床位的COVID-19定点诊疗中心，其中包含300张重症监护病房（Intensive Care Unit, ICU）床位。COVID-19的诊断经鼻拭子SARS-CoV-2-RT-PCR检测确认。本研究分析了2020年3月23日至5月23日期间所有住院患者的神经内科会诊申请。神经内科医师完成神经系统体格检查，评估所有可用临床资料以明确神经系统疾病诊断，并申请必要的额外检查项目。疑难病例通过多学科会诊明确诊断。确诊后，神经内科医师参与患者的治疗方案制定。
结果：该研究周期内，1208例住院COVID-19患者中共有89例（7.4%）提交了神经内科会诊申请。主要神经系统诊断包括：脑病（44.4%）、脑卒中（16.7%）、既往神经系统疾病（9.0%）、癫痫发作（9.0%）、神经肌肉疾病（5.6%）、其他急性脑病变（3.4%），以及其他轻度非特异性症状（11.2%）。
结论：COVID-19定点医院中绝大多数神经内科会诊申请针对的是可能影响患者预后的重症情况。一线临床医师应具备识别神经系统症状的能力；神经内科医师是COVID-19住院医疗团队中的重要组成成员。