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Observational Study
. 2021 Jul;268(7):2331-2338.
doi: 10.1007/s00415-020-10251-5. Epub 2020 Oct 7.

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

Nicola Rifino  1 , Bruno Censori  2   3 , Emanuela Agazzi  2 , Dario Alimonti  1   2 , Virginio Bonito  2 , Giorgia Camera  2 , Marta Zaffira Conti  2 , Camillo Foresti  2 , Barbara Frigeni  2 , Simonetta Gerevini  4 , Maria Grimoldi  2 , Sara La Gioia  2 , Tania Partziguian  2 , Stefano Quadri  2 , Riccardo Riva  2 , Maria Cristina Servalli  2 , Manlio Sgarzi  2 , Benedetta Storti  1 , Marcella Vedovello  2 , Elisabetta Venturelli  2 , Martina Viganò  1 , Annapaola Callegaro  5 , Marco Arosio  5 , Maria Sessa  6
Affiliations
Observational Study

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

Nicola Rifino et al. J Neurol. 2021 Jul.

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; χ2= 14.306; p < 0.0002) and with altered mental status (87.1% vs 55.6%; difference = 31.5% 95% CI 27.5-37.5%; χ2= 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.

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Conflict of interest statement

The authors declare that they have no competing interest.

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