There is overwhelming evidence to suggest that infection with severe acute respiratory syndrome (SARS-CoV-2) causes dysfunction of several organ systems, including the nervous system. Neurological symptoms are frequently reported even in patients with mild illness, and for some, these neurological symptoms may persist as part of long-lasting COVID-19.
To describe the prevalence, associated risk factors and consequences of severe neurologic manifestations in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, researchers from Boston University School of Medicine (BUSM) 16,225 patients from 179 hospitals were studied. 24 countries as part of the Society for Critical Care Medicine’s Viral Infections and Respiratory Illness University study.
The researchers found that about 13 percent of patients admitted for COVID-19 in the first year of the pandemic developed severe neurological manifestations. Specifically, 1,656 (10.2 percent) had encephalopathy (any diffuse disease of the brain that alters brain function or structure), 331 (2.0 percent) had a stroke, 243 (1.5 percent) had a stroke, and 73 (0.5 percent) had meningitis or encephalitis at admission or during hospitalization.
“Our findings suggest that encephalopathy is present in at least one in 10 patients with SARS-CoV-2 infection upon hospitalization, whereas stroke, seizures and meningitis/encephalitis are very common during admission or during hospitalization. were few,” explains corresponding author Anna Cervantes. —Arslanian, MD, associate professor of neurology, neurosurgery, and medicine at BUSM.
Additionally, they found that all severe neurologic manifestations were associated with increased disease severity, greater need for ICU intervention, longer stays, ventilator use, and higher mortality.
According to the researchers, patients with neurological manifestations were more likely to have medical comorbidities. Most notably, a history of stroke or neurological disorder increases the odds of developing a neurological manifestation.
In addition, they found that neurological manifestations differed by race. The frequency of stroke, seizures, and encephalopathy was increased in Black patients compared to White patients. “Given the association of neurologic manifestations with poor outcomes, further studies are desperately needed to understand why these differences occur and what can be done to intervene,” said Cervantes, who is a professor at Boston Medical Center. I am also a neurologist.
These findings appear online in the journal critical care exploration,
Funding for this study was provided by NIH/NCRR/NCATS CTSA grant number UL1 TR002377. The registry is funded by the Gordon and Betty Moore Foundation and Jensen Research and Development, LLC. Research electronic data capture support provided by Mayo Clinic.
Parts of these results were presented as an oral abstract at the annual meeting of the American Academy of Neurology (on April 5, 2022).
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