Neurological manifestations of coronavirus disease 2019 hospitalised patients in Punjab, India

Abstract

Introduction: Coronavirus disease 2019 (COVID-19), the disease linked to severe acute respiratory syndrome coronavirus-2, is a widespread infectious disease. Coronaviruses cause multiple systemic infections, but neurological involvement has been reported very rarely. Materials and Methods: The present study is a single-centre prospective study conducted during the COVID-19 pandemic from November 2020 to April 2021, at Mogamedicity Superspeciality Hospital, Punjab, India. All COVID-19 patients with de novo neurologic manifestations were eligible to take part in the study. A total of 810 confirmed COVID-19 patients were enrolled for the study. Demographic features and initial clinical manifestations were noted, and patients were followed up during the hospital stay for the development of any new neurological signs and symptoms. For analytical purposes, neurological presentations were grouped into the central nervous system, peripheral nervous system and musculoskeletal system manifestations. Appropriate laboratory testing was employed as required on a case-to-case basis. Results: In this study, the mean age of the patients was 46.6 ± 15.5 years. Five hundred and fifty two (66.9%) patients were male, while 268 (33.1%) were female. Neurological illness was a primary manifestation in 48 (6%) cases. These included encephalopathy (n = 30), ischaemic stroke (n = 4), Guillain–Barre syndrome, (n = 2), facial nerve palsy (n = 4) and encephalitis (n = 1). The most common neurological symptoms were headache (284 [35%]) and hyposmia (78 [9.6%]), followed by encephalopathy (68 [8.3%]). More serious complications such as seizures (14 [0.7%]) and stroke (18 [2.2%]) were also seen. Conclusion: COVID-19 can present with a neurological illness, and we should remain vigilant to the possibility of neurological presentation of COVID-19 that can be thrombo-embolic, inflammatory or immune-mediated.