Frequency, Onset and Clinical Impact of Neurological Symptoms in COVID-19 Disease: A Cohort Study on 576 Confirmed Cases

Abstract

Introduction: Coronavirus disease 2019 (Covid-19) might present neurologic symptoms. We aimed to evaluate the frequency and type of neurologic symptoms in patients with Covid-19 at the moment of emergency department (ED) visit, and their impact in the prognosis. Methods: Retrospective cohort study including all consecutive confirmed Covid-19 cases that were hospitalized between March 8th and April 11th, 2020. We compared, in patients with and without neurological symptoms on admission, demographic, clinical presentation, and frequency and type of abnormal laboratory values. We analyzed the variables that were associated with in-hospital all-cause mortality by Cox-regression log rank test. Results: We included 576 patients, 250 (43·3%) female, aged 67·2 years in mean. At the moment of ED visit, 320 (55·6%) patients described neurologic symptoms, including anosmia in 146 (25·3%), myalgia in 139 (24·1%), headache in 137 (23·8%) and altered mental status in 98 (17·0%). In those patients, neurologic symptoms started the first day of symptoms in 198 (54·2%) cases. Patients with neurologic symptoms presented later to the ED (7·9 vs. 6·6 days, p=0·019). In patients with neurologic symptoms, only four (0·6%) cases had not typical Covid-19 general symptoms and only six (1·9%) had a normal laboratory results at the moment of ED presentation, for a sensitivity of 98·7% (95% confidence interval (CI): 96·6-99·6%) and 98·1% (95% CI: 95·7-99·2%), respectively. In the multivariate Cox-regression analysis of mortality predictors, anosmia (HR: 0·358, 95%CI: 0·140-0·916) and altered mental status (HR: 1·867, 95%CI: 1·162-3·001) remained statistically significant. Conclusion: Neurologic symptoms were the most frequent extrapulmonary symptoms. They were present in half of the patients with Covid-19 at the time of the ED visit. In almost all of the cases, typical Covid-19 general symptoms and/or laboratory abnormalities were present. The presence of neurologic symptoms at the moment of ED presentation was an independent predictor of mortality. Funding Statement: The present study did not have any specific source of funding. Declaration of Interests: Authors declare not to have any conflict of interest. Ethics Approval Statement: The study was approved by the local ethics review board (PI-20-1751), which waived the need of written informed consent.