Neurological Manifestations of Non-Severe COVID-19-A Multidirectional Approach

Abstract

COVID-19 remains a significant clinical issue worldwide, with frequent neurological manifestations. In this study, the authors combine data obtained from the patient's medical history, physical examinations, and additional test results in the pursuit of any clinically relevant connections. Fifty-eight adult patients hospitalized in the Department of Neurology and Infectiology over a five-months period were retrospectively enrolled in this study. On admission, all patients included in this study were classified as mild or moderate COVID-19 cases, according to the World Health Organization (WHO) guidelines. Laboratory tests, Electroencephalography (EEG), and Magnetic Resonance Imaging (MRI) were performed. There was no statistically significant difference in the Neutrophil-Lymphocyte Ratio (NLR), C-reactive protein (CRP), and Interleukin 6 (IL-6) in patients who reported to the hospital within a week from the symptoms' onset and in those who reported later. In total, 49.06% of patients with eligible EEG recordings presented abnormal brain activity, while 27.59% of the study population had COVID-19-associated MRI findings. EEG and MRI abnormality occurrence did not correlate with the incidence of mild neurological symptoms (headache, olfactory, and gustatory disorders) of the SARS-CoV-2 infection. In three patients in this study population, unprovoked generalized epileptic seizures occurred for the first time in their life. Non-severe SARS-CoV-2 infection causes functional and structural abnormalities within the central nervous system. Brain microhemorrhages are frequently present in non-severe COVID-19 patients. There is no significant association between mild neurological symptoms of COVID-19 and additional test abnormalities. The time from SARS-CoV-2 infection's onset to hospital admission does not seem to influence the prognostic value of CRP, IL-6, and NLR in non-severe COVID-19. Mild-to-moderate SARS-CoV-2 infection can be a trigger factor for epilepsy and epileptic seizures.

Keywords: COVID-19; COVID-19 symptoms; EEG in COVID-19; MRI in COVID-19; SARS-CoV-2 infection; brain microhemorrhages; neuro-COVID-19.

Figure 1

Signs and symptoms of the SARS-CoV-2 infection in the study population.

Figure 2

Abnormalities recorded in the EEG examination in the study population.

Figure 3

MRI findings in the study population: (a) MRI study in patients with acute cerebral stroke, (b) MRI study in patients without acute cerebral stroke. Legend: Faz 1—hyperintense white matter foci on T2/FLAIR images meeting the Fazekas scale 1 criteria, Faz 2—hyperintense white matter foci on T2/FLAIR images meeting the Fazekas scale 2 criteria, WM—white matter. *—the incidence of this finding differed significantly (p < 0.05) between patients with and without acute cerebral stroke.