Neurological Manifestations in a Cohort of Egyptian Patients with COVID-19: A Prospective, Multicenter, Observational Study (original) (raw)
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Neuroepidemiology
Background: COVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study, we estimate the frequency of such complications among hospital inpatients with COVID-19 in Assiut and Aswan university hospitals. Materials and Methods: We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory tests, CT/MRI of the chest and brain, and neurophysiology study were performed for each patient if indicated. Results: 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these, 117 had acute neurological disease and the remainder had nonspecific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke and the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), rel...
Neuropsychiatric Disease and Treatment, 2021
Background: COVID-19 is a complex multisystem disease comprising multiple organ dysfunctions including neurologic manifestations. Some COVID-19 patients may present neurologic symptoms as the initial presentations of the disease. Objective: We aim at investigating the frequency and the predictors of neurological manifestations in patients with confirmed COVID-19. Methods: A retrospective cross-sectional single-center study analyzed COVID-19 positive patients with neurological manifestations from March to June 2020, in Aswan Governorate, Egypt. Demographic data, clinical, radiological and laboratory findings, comorbidities, and treatments were collected and analyzed. Results: Out of the 905 confirmed COVID-19 patients; 422 patients (46.6%) had neurological manifestations and fulfilled the study inclusion criteria, 223 patients (52.8%) had central neurological disorders (CNS), 107 (25.4%) had peripheral neurological disorders (PNS), and 92 (21.8%) patients had non-specific neurological disorders. Age >50 years, diabetes mellitus, CORAD> III and smoking were predictors for neurological system affection. Conclusion: COVID-19 infection has been associated with numerous neurological deficits, especially in elderly patients. Central nervous system disorders were the most prevalent deficit with predominance of cerebrovascular events.
Archives of Academic Emergency Medicine, 2021
Introduction: COVID-19 might present with other seemingly unrelated manifestations; for instance, neurological symptoms. This study aimed to evaluate the neurologic manifestations and their correlated factors in COVID-19 patients. Methods: This retrospective observational study was conducted from March 17, 2020 to June 20, 2020 in a tertiary hospital in Iran. The study population consisted of adult patients with a positive result for COVID-19 real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs. Both written and electronic data regarding baseline characteristic, laboratory findings, and neurological manifestations were evaluated and reported. Results: 727 COVID-19 patients with the mean age of 49.94 ± 17.49 years were studied (56.9% male). At least one neurological symptom was observed in 403 (55.4%) cases. Headache (29.0%), and smell (22.3%) and taste (22.0%) impairment were the most prevalent neurological symptoms, while seizure (1.1%) and ...
Acute Neurological Manifestations of COVID-19 Patients From Three Tertiary Care Hospitals in Qatar
Cureus, 2022
Introduction Worldwide, there are more than 424 million confirmed cases of COVID-19. Most of the hospitalized critical COVID-19 patients manifested neurological signs and symptoms and higher mortality. The majority of COVID-19 fatalities occurred mostly in patients with advanced age and underlying medical comorbidities. This is the first local retrospective study in Qatar, which reported neurologic manifestations (48.5%) of hospitalized COVID-19 patients. The primary objective of this study is to evaluate acute neurological manifestations in COVID-19 hospitalized patients in the country. Methods This is a retrospective, observational study of 413 hospitalized COVID-19 patients. They were admitted to three different COVID-19 designated hospitals (Hazm Mebaireek, Ras Laffan, and Cuban tertiary care Hospitals) under the Hamad Medical Corporation, Qatar from 1st January 2020, to 31 January 2021. We evaluated electronic medical records of these patients and data were collected while their neurological manifestations were confirmed by two trained neurologists. These neurologic manifestations were categorized into three major groups: central nervous system (CNS), peripheral nervous system (PNS), and neuromuscular system. Results Of 413 patients, 94% (389) were male and 6% (24) were female; the mean age was 52 years. Among all different nationalities of COVID-19 patients, 20.3% (84) were Indian, 12.5% (52) were Bangladeshi, 10.1% (42) were Qatari and 9.2% (38) were Nepali. The most common symptoms at the onset of COVID-19 illness were as follows: 77.5% (321) had a fever, 67.4% (279) experienced cough, 58.7% (243) experienced shortness of breath and 26.1% (108) developed a sore throat. Overall 48.5% (201) patients developed different neurologic manifestations. The most common neurologic symptoms were myalgia (28%; 116), headache (10.4%; 43), dizziness (5.8%; 24) and hemiparesis due to strokes (5.3%; 22). In this study, the most common risk factors were hypertension (47.6%), diabetes (46.9%), obesity (21%), chronic kidney disease (10%), ischemic heart disease (9.7%), and smoking (6.8%). About 45.2% (187) patients were admitted to MICU and 8.5% (35) died due to COVID-19 complications. Significant other extrapulmonary multiorgan system involvement were skeletal muscle injury (39.4%), kidney injury (36.7%), liver injury (27.5%), myocardial injury (23.9%), rhabdomyolysis (15.7%) heart failure (11.4%) and acute pancreatitis (11.1%). Discussion The most common neurologic signs and symptoms were myalgia, headache, dizziness, and strokes, mainly due to large vessel thrombosis, lacunar, and posterior circulation strokes. Conclusions Patients with COVID-19 are at high risk of developing neurological manifestations. The most common COVID-19-related acute neurological manifestations were myalgia, headache, dizziness, and acute ischemic stroke. Prompt recognition, early diagnosis, and appropriate management of these manifestations could potentially lead to better patient outcomes in COVID-19 patients. Categories: Internal Medicine, Neurology Keywords: intensive care unit-acquired weakness (icu-aw), creatine kinase (ck), acute disseminated encephalomyelitis (adem), acute respiratory distress syndrome (ards), severe acute respiratory syndrome coronavirus 2 (sars-cov-2), coronavirus disease 2019 (covid-19) 1, 2 1, 2 3 4 4 4 4 4 5 6 Open Access Original Article
Characteristics, onset, and evolution of neurological symptoms in patients with COVID-19
Neurological Sciences
Background A wide range of neurological manifestations has been described in COVID-19. Methods In this nationwide retrospective observational study, patients in Tunisia diagnosed with COVID-19 between the 2nd of March and the 16th of May 2020 were contacted by telephone. We collected demographic and clinical data and specified characteristics and evolution of main neurological symptoms. Results Of 1034 confirmed COVID-19 patients, 646 were included (mean age 42.17 years old) and 466 (72.1%) had neurological symptoms. Neurological symptoms were isolated 22.7% (n = 106). Headache was the most frequent neurological symptom (n = 279, 41.1%): mainly frontotemporal (n = 143, 51.1%) and mild or moderate (n = 165, 59.1%). When associated with fever (n = 143, 51.3%), headache was more likely to be severe and present at onset. Recovery was reported in 83.2%. Smell and taste impairment were found in 37.9% (n = 245) and 36.8% (n = 238) respectively. Among them, 65.3% (156/239) were anosmic and 63.2% (146/231) were ageusic. A complete improvement was found in 72.1% (174/240) of smell impairment and in 76.8% (179/ 233) of taste impairment. Myalgia (n = 241, 37.3%) and sleep disturbances (n = 241, 37.3%) were also frequent. Imported cases had more neurological symptoms (p = 0.001). In 14.5%, neurological symptoms preceded the respiratory signs (RS). RS were associated with more frequent (p = 0.006) and numerous (p < 0.001) neurological symptoms. Conclusions Neurological symptoms in COVID-19 are frequent, can be isolated and present at onset. A total recovery is the most recorded outcome. RS are predictive of neurological symptoms. Studies in to virus and host genetics should be considered to understand the different phenotypes.
Neurological manifestations in mild and moderate cases of COVID-19
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Background The coronavirus disease due to SARS COVID-2 emerged from Wuhan city in China in December 2019 and rapidly spread to more than 200 countries all over the world as a global health pandemic. Its primary presentation is respiratory and cardiac. However, some neurological manifestations are also reported. We tried to explore the reported neurological manifestations in a group of non-hospitalized mild and moderate COVID-19 patients. We contacted 107 patients via phone calls and e-mail messages, within 10 days of clinical presentation. The collected data regarded the neurological and non-neurological symptoms of the disease using a questionnaire that collected medical information of each patient. Results It is found that 100% of patients have been reported with at least one neurological symptom during the first 10 days of COVID-19 presentation. The most common were headache which recorded 72% of the total. Then anosmia–dysgeusia which reached 52%, then myalgia with 44%, fatigue ...
Deleted Journal, 2024
Background & Objective: In this study, we aimed to evaluate past medical and social history, initial symptoms, laboratory values, clinical course, and outcome of COVID-19 patients with neurological manifestations in Shahroud, Iran. Methods: In this cross-sectional study, data from all registered COVID-19 patients in Shahroud during March 2020 to July 2021 (n=30,228) were initially reviewed in terms of the prevalence of neurological symptoms. Additionally, the data of COVID-19 patients admitted to Shahroud's hospital (n=8,412) was evaluated in details according to the clinical profile, socio-demographic characteristics, laboratory findings, and in-hospital outcomes. Data were compared between COVID-19 patients with and without neurological manifestations. Predictive factors of ICU admission and mortality in COVID-19 patients with neurological manifestations were also evaluated. Results: Fever, chills, anorexia, myalgia, arthralgia, nausea, vomiting, cough, dyspnea, diarrhea and abdominal pain were significantly more common among COVID-19 patients with neurological symptoms compared to COVID-19 patients without such symptoms. Furthermore, smoking, drug abuse and history of underlying diseases were significantly more prevalent among the former group. Patients with neurological symptoms were more likely to be admitted to the hospital and ICU and had higher mortality rates. In terms of laboratory findings, hemoglobin, hematocrit, platelet count, and albumin levels were significantly lower in the patients with neurological symptoms. Age ≥ 50 years and history of underlying diseases were associated with increased ICU admission in COVID-19 patients with neurological manifestations. Conclusions: The following strategies could prove beneficial for COVID-19 patients: (i.) reduction of smoking and substance abuse, (ii.) close monitoring of more symptomatic patients and patients with a history of underlying diseases for neurological manifestations, (iii.) providing appropriate intensive care for older patients and those with underlying diseases who have neurological manifestations and (iv.) early detection of anemia, thrombocytopenia, and hypoalbuminemia.
Romanian Journal of Neurology
Objective. Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological symptoms. To compare the clinical features, imaging and treatments in patients with and without COVID-19. To compare the mortality and in-hospital stay among patients with and without COVID-19 and negative patients. Materials and methods. In this retrospective, single-center study, we included all the patients who attended the department of neurology with neurologic symptoms with confirmed COVID-19 and long COVID-19 from June 2020 to January 2021. Data on clinical signs, diagnosis, laboratory findings were collected and analyzed from the records for positive patients and compared with neurologic patients without COVID-19 admitted in the same period. Statistical analysis: The mean values between study groups were compared using an independent sample t-test and Mann Whitney u test. Categorical outcomes were compared using the Chi squ...
Acta Neurologica Belgica
Objective Since the beginning of the COVID-19 pandemic, a number of COVID-related neurological manifestations have been reported. We aimed to categorize the features of hospitalized COVID-19 patients who experienced neurological symptoms. Methods In this descriptive, cross-sectional study, we enrolled all patients hospitalized with COVID-19 who experienced neurological symptoms in two hospitals in Tehran. Diagnosis of COVID-19 was established by PCR tests or computed tomography of the chest combined with COVID-19 clinical findings. The clinical characteristics, laboratory data, and imaging findings from 365 patients were analyzed. Results The average patient age was 59.2 ± 16.7 years and included 213 males and 152 females. The most prevalent neurological symptoms were headache (56.2%), impaired consciousness (55%), and dizziness (20.5%). During hospitalization, most of the patients did not require mechanical ventilation (81.9%). The percentage of patients with end-organ damage was 9% and mortality was 15%. Regression analysis on the neurological symptoms indicated that the mortality rate of patients with headaches was 84% lower than for the other neurological symptoms. Hyperglycemia was significantly related with end-organ damage and mortality (p = 0.029, p = 0.08, respectively). New vascular lesions were evident on brain MRIs of 9 patients and brain CTs of 16 patients. Conclusion Among the neurological symptoms of patients with COVID-19, headache appeared to indicate a protective factor against development of end-organ damage as well as mortality.
Neurological manifestations of COVID-19 infection in acute and late phases: A case-control study
Neurology Asia, 2023
Background & Objective: The late-term neurological effects of COVID-19 are not fully understood yet. Herein, we aimed to determine if COVID-19-related acute and late-term neurological symptoms exist in the patient group that differs from the general population during the pandemic period. Methods: Two hundred fifty patients with a history of COVID-19, whose treatments were completed at least one month before enrollment, were examined together with a control group consisting of 150 individuals that lived in the same socio-cultural environment during the same period. A survey that included questions about possible neurological symptoms that might be related to the COVID-19 infection was completed in both groups. Results: The patient and control groups were mostly similar regarding the neurological symptoms in the pre-pandemic period. The control group did not report any new symptoms except ageusia during the pandemic period. Whereas a number of neurological symptoms such as headache, ageusia and anosmia, difficulty in thinking and planning, forgetfulness, clumsiness of one or both hands, dizziness, unsteadiness, numbness in both hands and feet, and neuropathic pain occurred during the infection. Neurological symptoms, except headache and unsteadiness, prolonged to the late-term with a decreased prevalence. Conclusion: The emergence of new neurological symptoms during the pandemic in those with COVID-19 disease, unlike the control group, suggested that these symptoms are related to the infection itself.