Neurologic complications of COVID-19

Objective: The SARS-Cov2 virus is protean in its manifestations, affecting
nearly every organ system.  However, nervous system involvement
and its impact on disease outcome are poorly characterized. The objective
of the study is to determine if neurological syndromes are associated with
increased risk of inpatient mortality. Methods: 581 hospitalized patients
with confirmed SARS-Cov2 infection, neurological involvement and
brain-imaging were compared to hospitalized non-neurological COVID-19
patients.  Four patterns of neurological manifestations were
identified –acute stroke, new or recrudescent seizures, altered mentation
with normal imaging, and neuro-COVID-19 complex. Factors present on
admission were analyzed as potential predictors of in-hospital mortality,
including sociodemographic variables, pre-existing comorbidities,
vital-signs, laboratory values, and pattern of neurological
manifestations. Significant predictors were incorporated into a
disease-severity score.  Patients with neurological
manifestations were matched with patients of the same age and disease
severity to assess the risk of mortality. Results:  4711 patients
with confirmed SARS-Cov2 infection were admitted to one medical system in
New York City during a 6-week period.  Of these, 581 (12%) had
neurological issues of sufficient concern to warrant
neuro-imaging.  These patients were compared to 1743
non-neurological COVID-19 patients matched for age and disease-severity
admitted during the same period. Patients with altered mentation (n=258, p
=0.04, OR 1.39, CI 1.04 – 1.86) or radiologically confirmed stroke (n=55,
p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age
and severity-matched controls.  Conclusions:  The
incidence of altered mentation or stroke on admission predicts a modest
but significantly higher risk of in-hospital mortality independent of
disease severity. While other biomarker factors also predict mortality,
measures to identify and treat such patients may be important in reducing
overall mortality of COVID-19.