Abstract
More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.
Highlights
In March 2020, the World Health Organization declared COVID-19 a pandemic disease with unknown consequences[1]
In a Chinese retrospective cohort, impaired consciousness was observed in 7.5% of COVID-19 patients, and in 14.8% of severe cases[5]
1,208 patients with confirmed COVID-19 were admitted to the hospital and 89 neurological consultation requests were placed (7.4%)
Summary
In March 2020, the World Health Organization declared COVID-19 a pandemic disease with unknown consequences[1]. In a Chinese retrospective cohort, impaired consciousness was observed in 7.5% of COVID-19 patients, and in 14.8% of severe cases[5]. Neurological signs are almost ubiquitous in very severe COVID-19 patients, with agitation or positive CAM-ICU findings noted in over 65% of cases[3]. COVID19 may be complicated by encephalopathy, headache, and stroke. More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds).
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