Abstract
Objectives: Evidences from either small series or spontaneous reporting are accumulating that SARS-CoV-2 involves the Nervous Systems. The aim of this study is to provide an extensive overview on the major neurological complications in a large cohort of COVID-19 patients.
Methods: Retrospective, observational analysis on all COVID-19 patients admitted from February 23rd to April 30th, 2020 to ASST Papa Giovanni XXIII, Bergamo, Italy for whom a neurological consultation/neurophysiological assessment/neuroradiologic investigation was requested. Each identified neurologic complication was then classified into main neurologic categories.
Results: Of 1760 COVID-19 patients, 137 presented neurologic manifestations that manifested after COVID-19 symptoms in 98 pts and was the presenting symptom in 39. Neurological manifestations were classified as: (a) cerebrovascular disease [53 pts (38.7%)] including 37 ischemic and 11 haemorrhagic strokes, 4 transient ischemic attacks, 1 cerebral venous thrombosis; (b) peripheral nervous system diseases [31 (22.6%)] including 17 Guillain-Barrè syndromes; (c) altered mental status [49 (35.8%)] including one necrotizing encephalitis and 2 cases with RT-PCR detection of SARS-Cov-2 RNA in CSF; (d) miscellaneous disorders, among whom 2 patients with myelopathy associated with Ab anti-SARS-CoV-2 in CSF. Patients with peripheral nervous system involvement had more frequently severe ARDS compared to patients with cerebrovascular disease (87.1% vs 42%; difference = 45.1% 95% CI 42.0-48.2; χ 2 = 14.306; p < 0.0002) and with altered mental status (87.1% vs 55.6%; difference = 31.5% 95% CI 27.5-37.5%; χ 2 = 7.055; p < 0.01).
Conclusion: This study confirms that involvement of nervous system is common in SARS-CoV-2 infection and offers clinicians useful information for prevention and prompt identification in order to set the adequate therapeutic strategies.
Keywords: Altered mental status; COVID-19; Cerebrovascular diseases; Infectious diseases; Peripheral neuropathies.
【저자키워드】 COVID-19, Infectious diseases, Altered mental status, cerebrovascular diseases, Peripheral neuropathies., 【초록키워드】 SARS-CoV-2, SARS-COV-2 infection, Symptom, Italy, anti-SARS-CoV-2, Encephalitis, RNA, Patient, Therapeutic strategies, nervous system, large cohort, information, COVID-19 patients, RT-PCR detection, CSF, Analysis, neurological, Cerebrovascular disease, COVID-19 patient, manifestation, Neurological complication, cerebrovascular, COVID-19 symptom, 95% CI, disorders, clinician, severe ARDS, categories, offer, attacks, neurologic, Mental, peripheral, venous, nervous, nervous system disease, Bergamo, manifested, presenting, Altered, accumulating, had more, 【제목키워드】 Italy, COVID-19 patient, manifestation, Bergamo,