A Study on Neurological Manifestations in Coronavirus Disease 2019 Patients Admitted to a Tertiary Care Hospital.

Abstract

The coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, the involvement of other organs needs to be explored. Thus, this study is undertaken to analyze the neurological manifestations in patients with COVID-19 infection. To analyze the neurological manifestations in patients with COVID-19 infection. All COVID-19-positive patients who got neurology referrals from March 2020 to June 2021 were included in the study. Laboratory confirmation of COVID-19 infection was done by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of throat swabs in patients who present with symptoms suggestive of COVID-19. Demographic characteristics, neurological complaints, comorbid conditions, neurological examination, and requisite investigations were analyzed. Among 160 patients, 107 (67%) were men, and the mean age was 61 years. Comorbidities included diabetes mellitus (51%) of subjects followed by hypertension (28%), chronic kidney disease (10%), and coronary artery disease (5%). Considering the COVID-19 severity, 28.75% had mild; 8.75% had moderate; and 62.5% had severe disease. The most common neurological symptoms included altered sensorium (62.5%), focal neurological symptoms (29.4%), anosmia (13.1%), headache (10.6%), and seizures (7.5%). The most prevalent neurological signs and/or syndromes were acute encephalopathy (62.5%), stroke (21.3%%), and mucormycosis (12.5%). The mortality rate in our study population was 16.3%, encephalopathy being the most common cause. In our study, encephalopathy was the major cause of morbidity and mortality among the COVID-19-related neurological manifestations. Encephalopathy was most seen in severe COVID-19 infection and was associated with increased neutrophil-to-lymphocyte (NL) ratio raised inflammatory markers. Stroke constituted 29.4% of the neurology referrals in COVID-19 patients confirming COVID-19 infection predisposes to thrombotic events. We found an increased incidence of Mucormycosis in COVID-19 patients, but early debridement and timely treatment with antifungal medications had reduced the mortality.