Neurological Symptoms and Complications of COVID-19 Among Patients in a Tertiary Hospital in Saudi Arabia

Abstract

Objectives In this study, we aimed to determine the frequency of neurological signs, symptoms, and complications in coronavirus disease 2019 (COVID-19) patients. We also sought to explore the general characteristics of stroke patients in particular. Methods A retrospective cohort study was conducted among COVID-19 patients who were hospitalized between April-September 2020 at the Al-Noor Specialist Hospital in Makkah city, Saudi Arabia. The study included patients who were aged ≥18 years and presented with or were reported to have any neurological manifestations and/or complications secondary to COVID-19 infection. Results A total of 79 patients were included. The mean age of the cohort was 63.6 years, with a significant male predominance (67.1%). The most commonly reported neurological signs and symptoms were altered level of consciousness (45.9%), dizziness (11.5%), and focal neurological deficit (10.4%). Acute ischemic stroke was seen in 18 patients. Most of them were males (66.7%). Most strokes were in the right middle cerebral artery territory (MCA) (50.0%). Diabetic patients were four times more at risk to develop stroke [odds ratio (OR)=3.76; 95% confidence interval (CI): 1.1-29.9]. Patients with respiratory failure were 21 times more likely to have a stroke (OR=21.3; 95% CI: 2.2-54.6). Patients with acute respiratory distress syndrome recorded a three-fold increased risk for developing stroke (OR=2.96; 95% CI: 1.25-37.3). Critically ill patients had double the risk of stroke (OR=1.8; 95% CI: 1.1-6.9). Other neurological complications were hemorrhagic stroke (3.3%), subacute/chronic infarction (23.3%), meningitis (10%), and brain mass lesion (3.3%). Conclusions Neurological symptoms and complications are not uncommon among COVID-19 patients. Most of these patients had poor outcomes. Acute ischemic stroke was the most common finding on neuroimaging.

Keywords: covid-19; neurologic manifestations; sars-cov-2; saudi arabia; stroke.

Figure 1. Flow chart summarizing the characteristics of the study sample

COVID-19: coronavirus disease 2019

Figure 2. Severity of COVID-19 infection among patients with neurological symptoms or complications (n=79)

COVID-19: coronavirus disease 2019

Figure 3. Non-contract CT scan of the brain of two patients with COVID-19 who had acute cerebrovascular complications

(A) Large mass lesion. (B) Bilateral severe atrophic changes with diffuse extensive white matter hypodensities. (C) Loss of gray/white matter differentiation in the left parietal region. (D) Bilateral occipitotemporal loss of gray/white matter differentiation CT: computed tomography; COVID-19: coronavirus disease 2019