Neurologic manifestations in 1760 COVID-19 patients admitted to Papa Giovanni XXIII Hospital, Bergamo, Italy

• Published in: Journal of neurology Vol. 268; no. 7; pp. 2331 - 2338
• Main Authors: Rifino, Nicola, Censori, Bruno, Agazzi, Emanuela, Alimonti, Dario, Bonito, Virginio, Camera, Giorgia, Conti, Marta Zaffira, Foresti, Camillo, Frigeni, Barbara, Gerevini, Simonetta, Grimoldi, Maria, La Gioia, Sara, Partziguian, Tania, Quadri, Stefano, Riva, Riccardo, Servalli, Maria Cristina, Sgarzi, Manlio, Storti, Benedetta, Vedovello, Marcella, Venturelli, Elisabetta, Viganò, Martina, Callegaro, Annapaola, Arosio, Marco, Sessa, Maria
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2021; Springer Nature B.V
• Subjects: Central nervous system diseases; Cerebrospinal fluid; Cerebrovascular disease; Cerebrovascular diseases; Coronaviruses; COVID-19; COVID-19 - complications; Encephalitis; Hospitals; Humans; Ischemia; Italy; Medicine; Medicine & Public Health; Nervous system; Nervous System Diseases - virology; Neurological complications; Neurology; Neuroradiology; Neurosciences; Original Communication; Polymerase chain reaction; Retrospective Studies; RNA, Viral; Severe acute respiratory syndrome coronavirus 2; Spinal cord; Thrombosis; Italy; COVID-19; Infectious diseases; Altered mental status; Cerebrovascular diseases; Peripheral neuropathies
• DOI: 10.1007/s00415-020-10251-5
• EISSN: 1432-1459
• ISSN: 0340-5354

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.