Factors Associated With Neurological Manifestations in Patients With COVID-19

The coronavirus disease 2019 (COVID-19) is the most terrible pandemic of a respiratory disease that we had in the past century. Most existing studies explore different manifestations in COVID-19. Few recent studies have described neurological manifestations of patients with COVID-19 but their associations with age, laboratory findings, and mortality rates have not been explored well.

This case-control study includes 263 patients with COVID-19 without neurological symptoms (control group) and all patients with COVID-19 with the central nervous system symptoms (n = 460, case group) hospitalized between February 2020 and April 2020. Data on demographic factors, medical history, symptoms, and laboratory tests, all are extracted from medical records.

Out of 723 patients with confirmed SARS-CoV-2 infection, 460 (63.6%) were identified to have at least one neurological manifestation. The mean ages of patients with and without neurological manifestation were 60.6 ± 18.0 and 60.8 ± 15.7 years, respectively. The most common symptoms were myalgia (41%), headache (20.3%), and loss of consciousness (LOC) (16.5%). Women were more likely to develop a neurological manifestation (P = 0.001). Moreover, smoking history was significantly more in patients with neurological manifestations (P = 0.03). Also, we compared two groups in terms of tracheal intubation. The need for tracheal intubation was 19% and 12% in patients with and without neurological manifestations, respectively. Furthermore, the prevalence of intensive care unit (ICU) admission was 28% and 24% in patients with COVID-19, with and without neurological manifestations, respectively. Some of the neurological manifestations such as LOC, limbs weakness, and seizure might need more ICU admission and tracheal intubation. The frequency of comorbidities and the laboratory test results were almost similar between the two groups.

Myalgia, headache, and LOC were the most common neurological manifestations and their distributions varied depending on age. Only a few neurological manifestations were related to mortality and morbidity rates, while some of them occurred in mild cases.