New onset neurologic events in people with COVID-19 infection in three regions in China

Objective: To investigate new-onset neurologic impairments
associated with coronavirus disease 2019 (COVID-19). Methods:  A
retrospective multicenter cohort study conducted between 18 January and 20
March 2020 including people with confirmed COVID-19 from 56 hospitals
officially designated in three Chinese regions; data were extracted from
medical records. New-onset neurologic events as assessed by neurology
consultants based on manifestations, clinical examination and
investigations, in which critical events included disorders of
consciousness, stroke, CNS infection, seizures and status epilepticus.
Results:  We enrolled 917 people with average age 48.7
years and 55% were male. The frequency of new onset critical neurologic
events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe
or critical COVID-19. These were impaired consciousness (n=25) or/and
stroke (n=10). The risk of critical neurologic events was highly
associated with age above 60 years and previous history of neurological
conditions. Non-critical events were seen in less than 1% (7/917),
including muscle cramp, unexplained headache, occipital neuralgia, tic and
tremor. Brain CT in 28 people led to new findings in nine. Findings from
lumbar puncture in three with suspected CNS infection, unexplained
headache or severe occipital neuralgia were unremarkable.
Conclusions:  People with COVID-19 aged over 60 and
neurologic comorbidities were at higher risk of developing critical
neurologic impairment, mainly impaired consciousness and cerebrovascular
accidents. Brain CT should be considered when new-onset brain injury is
suspected, especially in people under sedation or showing an unexplained
decline in consciousness. Evidence of direct acute insult of SARS-COV-2 to
the CNS is still lacking.