Composite neurological outcomes in patients with COVID-19 infection from a multicenter health System

Objective: To identify common neurological complications in COVID-19 patients. Background: The novel Sars-CoV-2 virus was declared a Pandemic by WHO on March 11, 2020. Majority of the data published at this time brings into light the profound respiratory distress and cardiovascular outcomes however much is left to be discovered as far as neurological outcomes are concerned as suggested by anecdotal evidence and limited data. Design/Methods: We conducted a retrospective observational study from January 1, 2020 to April 30, 2020 on data collected from a multicenter health system based in Kansas City Metro area in United States. Composite neurological outcomes from the data included seizures (new onset), delirium (requiring medications), hemorrhagic and ischemic strokes (new onset, diagnosed > 48-72 hours after hospitalization). Results: Of the 346 people who tested positive for COVID-19, 89 (25.7%) were admitted to the hospital with 27 (30%) of the admitted patients requiring ICU level of care at some point. Delirium was seen in 19 patients (21%) of the total admitted out of which 14 patients (51%) were in the ICU. We observed a total of 2 cases of stroke, one ischemic and one hemorrhagic (2.2% of admitted patients). Seizures were not observed in this cohort of patients. Conclusions: Contrary to anecdotal data, we did not observe significant number of patients experiencing seizures or strokes in this cohort of patients. COVID-19 patients admitted to the hospital were documented to have significant levels of delirium. It is unclear as to why delirium was highly prevalent, could this be due to underlying ARDS or attributable to the critical condition or can it be a primary neurological outcome of COVID-19 is yet to be established. It would however benefit clinicians to closely monitor for worsening mentation or neurologic examination in COVID-19 patients.