Global Prevalence of Neurological Manifestations Among Patients Hospitalized with COVID-19: A Report of the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) and the European Academy of Neurology [ENERGY] Registry Collaborative

Background: The novel coronavirus disease 2019 (COVID-19) pandemic continues to affect millions globally, with increasing reports of COVID-19 neurological manifestations but limited data on their population prevalence and outcome. This is the first report from two international consortia studies aimed to determine the neurological phenotypes, prevalence, and outcomes among hospitalized COVID-19 patients.   Methods: The Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) is a multi-center cohort study enrolling consecutive hospitalized COVID-19 patients to determine type, prevalence, and outcomes of COVID-19 neurological manifestations. The European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY) is a global registry to capture COVID-19 neurological manifestations and outcomes.  Using harmonized data elements across two consortia, this is the first report describing 3744 subjects from 28 centers, representing 13 countries and 4 continents.  Findings: Data are presented from three separate cohorts: the GCS-NeuroCOVID “ALL COVID” cohort (n=3055), which includes consecutive hospitalized COVID-19 patients with and without neurological manifestations, the GCS-NeuroCOVID “COVID NEURO” cohort (n=475), consisting of consecutive hospitalized COVID-19 patients with confirmed neurological manifestations, and the ENERGY cohort (n=214), which includes COVID-19 patients with a neurological consultation.  Across cohorts, neurological manifestations are present in up to 80% of hospitalized COVID-19 patients. The most common self-reported neurological symptoms included headache (38%) and anosmia/ageusia (28%).  The most common neurological signs/syndrome are acute encephalopathy (50%), coma (17%), and stroke (3%) while meningitis/encephalitis are rare (0.1%).  Pre-existing neurological disorders is associated with higher risk for developing new neurological signs/syndromes with COVID-19, which in-hospital mortality after adjusting for age, sex, race, and ethnicity.  Interpretation:  Neurological manifestations are prevalent across hospitalized COVID-19 patients in two large global consortia representing North America, Europe, Asia and Africa. Having neurological manifestations with COVID-19 is associated with higher in-hospital mortality.  Subsequent studies are needed to determine potential pathophysiologic mechanisms and long-term outcomes of COVID-19 neurologic manifestations. Funding Statement: National Center for Advancing Translational Sciences (NCATS) UL1 TR001857 (Chou); National Institutes of Neurological Disorders and Stroke (NINDS) R21NS113037 (Chou). Declaration of Interests: Chou S H-Y declares no interests. Beghi E declares no interests. Helbok R declares no interests. Moro E declares no interests. Sampson J declares no interests. Altamirano V declares no interests. Mainali S declares no interests Basetti C declares no interests. Suarez J declares no interests. McNett M declares no interests. Ethics Approval Statement: The central coordinating center (University of Pittsburgh) established ethics approval for a multicenter study, confirmed local ethics approval and executed data use agreements with each participating site.