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. 2023 Oct 4;23(1):351.
doi: 10.1186/s12883-023-03399-w.

Neurological disorders associated with COVID-19 in Sri Lanka

Thashi Chang  1 , Ruwani Wijeyekoon  2 , Ajantha Keshavaraj  3 , Udaya Ranawaka  4 , Sunethra Senanayake  5 , Pyara Ratnayake  6 , Bimsara Senanayake  5 , Manjula C Caldera  7 , Gamini Pathirana  5 , Darshana Sirisena  8 , Jithangi Wanigasinghe  9 , Saman Gunatilake  10 ; ASN COVID-19 Study Group
Collaborators, Affiliations

Neurological disorders associated with COVID-19 in Sri Lanka

Thashi Chang et al. BMC Neurol. .

Abstract

Background: Neurological manifestations of SARS-CoV-2 infection have been reported from many countries around the world, including the South Asian region. This surveillance study aimed to describe the spectrum of neurological disorders associated with COVID-19 in Sri Lanka.

Methods: COVID-19 patients manifesting neurological disorders one week prior and up to six weeks after infection were recruited from all the neurology centres of the government hospitals in Sri Lanka from May 2021 - May 2022. Data was collected using a structured data form that was electronically transmitted to a central repository. All patients were evaluated and managed by a neurologist. Data were analysed using simple descriptive analysis to characterise demographic and disease related variables, and simple comparisons and logistic regression were performed to analyse outcomes and their associations.

Results: One hundred and eighty-four patients with neurological manifestations associated with COVID-19 were recruited from all nine provinces in Sri Lanka. Ischaemic stroke (31%) was the commonest neurological manifestation followed by encephalopathy (13.6%), Guillain-Barre syndrome (GBS) (9.2%) and encephalitis (7.6%). Ischaemic stroke, encephalitis and encephalopathy presented within 6 days of onset of COVID-19 symptoms, whereas GBS and myelitis presented up to 10 days post onset while epilepsy and Bell palsy presented up to 20 - 40 days post onset. Haemorrhagic stroke presented either just prior to or at onset, or 10 - 25 days post onset of COVID-19 symptomatic infection. An increased frequency of children presenting with encephalitis and encephalopathy was observed during the Omicron variant predominant period. A poor outcome (no recovery or death) was associated with supplemental oxygen requirement during admission (Odds Ratio: 12.94; p = 0.046).

Conclusions: The spectrum and frequencies of COVID-19 associated neurological disorders in Sri Lanka were similar to that reported from other countries, with strokes and encephalopathy being the commonest. Requiring supplemental oxygen during hospitalisation was associated with a poor outcome.

Keywords: COVID-19; Neurology; SARS-CoV-2; Sri Lanka.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Monthly frequencies of reported COVID-19 associated neurological disorders (red – left Y axis) relative to monthly nationally reported COVID-19 cases in Sri Lanka (blue – right Y axis). Percentages indicate monthly reported COVID-19 associated neurological disorders as a percentage of monthly nationally reported COVID-19 cases. Horizontal bars indicate predominant COVID-19 variant reported to be present in Sri Lanka during the relevant periods
Fig. 2
Fig. 2
Classification of main neurological diagnoses reported as associated with COVID-19. (ADEM—acute disseminated encephalomyelitis; CNS—central nervous system)
Fig. 3
Fig. 3
Spectrum of neurological disorders in relation to the predominant COVID-19 variant present at the time in Sri Lanka
Fig. 4
Fig. 4
Violin plot showing time of onset of neurological disorders in relation to the onset of COVID-19 symptoms denoted as time point 0 day. (GBS: Guillain–Barre syndrome)
Fig. 5
Fig. 5
Outcomes of the key neurological disorders associated with COVID-19
See this image and copyright information in PMC

References

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Supplementary concepts