Neurological Manifestations in Hospitalized Patients with COVID-19: A Retrospective, Observational Study from a Spanish Population. The ALBACOVID Registry

Background: The coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019. Spain is one of the most affected countries, with high incidence and mortality rates. Neurological symptoms have been reported as part of the clinical spectrum of the disease. We aim to describe the prevalence and characteristics of neurological manifestations of COVID-19. Methods: We systematically review all patients diagnosed with COVID-19 admitted to hospital in a Spanish population during March 2020, in the course of the COVID-19 outbreak. Demographic characteristics, systemic and neurological clinical manifestations, and complementary tests were analysed. Results: Of 841 patients hospitalized with COVID-19 (mean age 66·4 years, 56.2% men) 57·4% developed some neurological symptom. In 21 patients (2·5%), the neurological manifestation was the reason to visit the emergency department. Nonspecific symptoms such as myalgias (17·2%), headache (14·1%), and dizziness (6·1%) were present mostly in early stages of infection. Anosmia (4·9%) and dysgeusia (6·2%) also tended to occur early (60% as first clinical manifestation) and were more frequent in less severe cases (p=0·02). Disorders of consciousness occurred commonly (19·6%), mostly in older patients (p<0·001) and in severe and advanced COVID-19 stages (p<0·001). Myopathy (3·1%), dysautonomia (2·5%), cerebrovascular diseases (1·7%), seizures (0·7%), movement disorders (0·7%), encephalitis (1 case) and optic neuritis (1 case) were also reported, but less frequent. Neurological complications were the cause of death in 4·1% of all deceased. Conclusions: Neurological manifestations are common in COVID-19 hospitalized patients. In our series, more than half of patients presented with some neurological symptom. Clinicians need to maintain close neurological surveillance for prompt recognition of these complications in order to avoid delays in the establishment of proper treatment. The investigation of the mechanisms and upcoming consequences of neurological involvement of SARS-CoV-2 require further studies. Funding Statement: None Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was approved by the Ethics Committee of Complejo Hospitalario Universitario de Albacete, Spain, on April 18, 2020. Written informed consent was waived since all data were collected retrospectively and anonymously.