Infectious Disease

Neurological manifestations in sufferers with COVID-19 result in an elevated threat of mortality

December 22, 2020

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Neurological syndromes on admission in patients with COVID-19, including altered mentation and stroke, predicted a higher risk of mortality in a large single-center study in New York City, as published in Neurology.

“It remains unclear whether acute neurological manifestations affect mortality from SARS-CoV-2 disease and whether this risk exists in the absence of imaging results,” the researchers wrote. “The aim of this study was to evaluate the factors present at inclusion – sociodemographic data, medical comorbidities, vital functions, laboratory tests, and patterns of neurological syndromes – as potential predictors of hospital mortality.”

Emad N. Eskandar, MD, MBA, Professor in the Departments of Neurological Surgery, Psychiatry, and Behavioral Sciences, and Neuroscience, and Chairman of the Department of Neurological Surgery of Leo M. Davidoff at Albert Einstein College of Medicine, and colleagues examined data from 4,711 patients with confirmed COVID-19 infection admitted to a medical center in New York City for 6 weeks. Twelve percent of these patients (n = 581) had neurological complications significant enough to warrant imaging. The researchers compared this group to patients with COVID-19 who showed no neurological symptoms; The patients who were admitted at the same time as the patients with neurological symptoms were matched for age and severity of the disease.

Using a computer algorithm, the researchers performed a random search of the other 4,130 patients to find patients of the same age with a COVID-19 severity with no neurological manifestations. According to the study data, this search resulted in a matched control cohort of 1,743 patients.

Eskandar and colleagues identified five patterns of neurological manifestations. These included altered mentation (present in 44% of patients in the neurological group versus 5.5% of the total SARS-CoV-2 group), normal mentation with other neurological signs and symptoms compatible with COVID-19 (37% versus 4.6%)), stroke (9% vs. 1.2%), seizures (4% vs. 0.7%) and other brain lesions (4% vs. 0.6%).

The researchers observed an increased mortality risk in patients with altered mentation (n = 258; OR = 1.39, 95% CI, 1.04-1.86) and radiologically confirmed stroke (n = 55; OR = 3.1, 95 % CI, 1.65-5.92)) compared to controls matched for age and COVID-19 severity. The results showed a trend towards a higher mortality risk in patients with impaired arousal compared to patients with impaired cognition. Both researchers looked at symptoms of altered mentation, although this trend did not reach statistical significance.

The neurological findings reported in this study were consistent with those of other large cohort studies, according to Eskandar and colleagues. In contrast to other reports, however, the present study did not show any significant differences in mortality between Black and Latinx populations when controlled for comorbid underlying diseases.

“This further suggests that differences in score based on race and ethnicity are less related to biases within the health-related bias and are more due to structural and systemic racism, leading to inequality of health in terms of comorbid conditions and general Health of leads populations, ”the researchers wrote. “We believe that these results are consistent in the neurological area as with the SARS-CoV-2 infection itself.”

The present study was the largest to date to analyze the neurological manifestations of COVID-19 and their effects on mortality, the researchers said. Documented central nervous system manifestations in patients hospitalized with COVID-19, including encephalopathy, stroke, seizure, and syncope, are “relatively common”, although the actual incidence is likely “much higher” than the documented rate of 13%.

“Within the spectrum of CNS manifestations, altered mentation and stroke carry a higher risk of mortality that goes beyond the severity of the underlying disease,” wrote Eskandar and colleagues. “The presence of these syndromes may represent another clinically important syndromic expression of SARS-Cov-2 infection that carries a higher risk of mortality and may benefit from targeted treatment.”

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