Case series of neurological complications in patients with COVID-19 infection in a tertiary care hospital

Objective: To report the clinical course, neurological complications and outcomes of thirty one patients admitted with diagnosis of COVID-19 in a tertiary care hospital. Background: There have been several case reports of various neurological manifestations of COVID-19. Patients can present with focal and or generalized neurological deficits including stroke, seizures, encephalopathy and meningitis. Design/Methods: Electronic medical records of patients who presented with or developed neurological symptoms and were diagnosed with COVID-19 were reviewed. Results: Charts of 31 patients were reviewed. Majority of the patients were male with only 7 female patients. The presenting age group varied between 35-80 years with majority of patients above the age of 60. About 50% of the patients were African American. The most common presenting neurological symptoms were acute change in mental status, followed by focal deficits including right or left hemiparesis, speech impairment (aphasia), headache and loss of sense of taste. During admission, 18 patients were diagnosed with acute stroke, 1 patient suffered from intracerebral and intraventricular hemorrhage, 2 were diagnosed with encephalitis and the rest were diagnosed with acute encephalopathy. Two patients developed seizures during their hospital course and another two patients were diagnosed with status epilepticus. All patients were treated with hydroxychloroquine, broad spectrum antibiotics, vitamins but only 50% were treated with prednisone. Two patients underwent thrombectomy, 2 received Intravenous alteplase and 2 patients received Intravenous Immunoglobulin. 20 patients required Intensive Care Unit stay and suffered from systemic complications - sepsis, respiratory failure, hypoxia and kidney failure. Majority of the patients were discharged to subacute rehabilitation, 6 were discharged home and 10 patients died. Length of stay varied between 2-45 days. Conclusions: COVID-19 can manifest with acute focal and or generalized neurological symptoms. In our experience, a third of patients presenting with/developing neurological symptoms passed away and two-thirds of patients recovered though most required rehabilitation.