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Neurological manifestations of COVID-19: a retrospective observational study based on 1060 patients with a narrative
Alberto Negro1, Mario Tortora2, Laura Gemini2
1Department of Neuroradiology, Ospedale del Mare, Naples, Italy.
Insights
Neuroimaging revealed that 33.6% of hospitalized COVID-19 patients exhibited neurological abnormalities. Acute ischemic stroke was the most common finding, followed by Guillain-Barre syndrome and cerebral venous thrombosis.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, can manifest with extrapulmonary symptoms.
- Previous coronavirus epidemics highlight the potential for severe respiratory syndrome viruses to cause widespread organ damage.
Approach:
- A retrospective analysis of 1060 hospitalized COVID-19 patients was conducted.
- Detailed radiological assessment and a systematic literature review focused on neuroimaging findings in COVID-19.
Key Points:
- Of 143 patients with neuroimaging, 33.6% showed abnormalities.
- The most frequent neurological finding was acute ischemic stroke (33.3%).
- Other significant findings included Guillain-Barre syndrome (18.8%), cerebral venous thrombosis (14.6%), and encephalitis/myelitis (12.5%).
Conclusions:
- COVID-19 frequently presents with diverse neurological manifestations.
- Recognizing these neuroimaging patterns is crucial for diagnosing COVID-19 in patients with unexplained neurological symptoms.
Background:
In the past two decades, three coronavirus epidemics have been reported. Coronavirus disease 2019 (COVID-19) is caused by a severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2). In most patients, the disease is characterized by interstitial pneumonia, but features can affect other organs.
Purpose:
To document the radiological features of the patients and to perform a narrative review of the literature.
Material And Methods:
We conducted a retrospective, single-center study on 1060 consecutive hospitalized patients with COVID-19 at our institution. According to the inclusion criteria, we selected patients to be studied in more radiological detail. All images were obtained as per standard of care protocols. We performed a statistic analysis to describe radiological features. We then presented a systematic review of the main and conventional neuroimaging findings in COVID-19.
Results:
Of 1060 patients hospitalized for COVID-19 disease, 15% (159) met the eligibility criteria. Of these, 16 (10%) did not undergo radiological examinations for various reasons, while 143 (90%) were examined. Of these 143 patients, 48 (33.6%) had positive neuroimaging. We found that the most frequent pathology was acute ischemic stroke (n=16, 33.3%). Much less frequent were Guillain-Barre syndrome (n=9, 18.8%), cerebral venous thrombosis (n=7, 14.6%), encephalitis or myelitis (n=6, 12.5%), intracranial hemorrhage and posterior hemorrhagic encephalopathy syndrome (n=4, 8.3%), exacerbation of multiple sclerosis (n=4, 8.3%), and Miller-Fisher syndrome (n=2, 4.2%).
Conclusion:
Our data are coherent with the published literature. Knowledge of these patterns will make clinicians consider COVID-19 infection when unexplained neurological findings are encountered.
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