Neurological manifestations and mortality in hospitalized coronavirus disease 2019 patients

Abstract

Purpose: The purpose of the study is to analyze the neurological manifestations and to determine the association between these symptoms and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and Methods: Five hundred and forty-seven hospitalized patients with positive reverse transcriptase-polymerase chain reaction tests for severe acute respiratory syndrome coronavirus in a nasopharyngeal swab were included in this study. The demographic features, laboratory data, and radiologic imaging, neurological symptoms of hospitalized patients with COVID-19 were collected. Results: Of 547 hospitalized COVID-19 patients, the median age was 61 (range 18–93), 61.4% were male. Three hundred and forty-seven (63.4%) patients had a severe infection and 200 (36.6%) patients had a mild infection. Eighty-eight patients (16.1%) died during hospitalization. One hundred and fifty-four (28.2%) patients had at least one neurological symptom. Thirty-five (6.4%) patients manifested with only neurological symptoms at hospital admission. The most frequent neurological symptoms were headache (15.2%), taste and smell disorders (9.1%), and myalgia (6.6%). The other initial neurological manifestations were acute cerebral ischemic stroke, impaired consciousness, epileptic seizure, and posterior reversible encephalopathy. The late-onset neurological complications were autoimmune encephalitis and Guillain-Barre syndrome. The neurological manifestation was linked to the severity of disease (P = 0.005) but not correlated with mortality (P = 0.137). Conclusion: Neurological symptoms were frequent in COVID-19 patients. The neurological symptoms can be the initial symptoms or can be late-onset complications of COVID-19.