Neurologic Aspects of Coronavirus Disease of 2019 Infection

Catherine E. Hassett; Jennifer A. Frontera


Curr Opin Infect Dis. 2021;34(3):217-227. 

In This Article

Clinical Neurologic Findings in Coronavirus Disease-2019 Patients

The majority of our knowledge of neurologic complications of SARS-CoV-2 is derived from hospitalized COVID-19 patients (Table 1). One of the largest prospective, multicenter studies reported new neurologic events occur in approximately 14% of hospitalized COVID-19 patients.[34] These neurologic symptoms occurred within a median of 2 days from initial COVID-19 symptom onset and over two-thirds experienced neurologic events prior to their admission. The most common neurologic diagnoses were toxic-metabolic encephalopathy, stroke, seizure, and hypoxic-ischemic brain injury. COVID-19 patients with the neurologic diagnosis were more likely to be critically ill with higher rates of mechanical ventilation, ventilator days, and hospital length of stay. There was also a 38% increased risk of in-hospital death for the COVID-19 patient with a new neurologic complication and 35% of COVID-19 patients with neurological complications died compared to 19% of hospitalized COVID-19 patients without a new neurological event. This high mortality rate may, in part, reflect the impact of limited hospital resources in the context of a crisis surge of patients. In a concurrent study conducted in a city not undergoing a surge with a similar proportion of ventilated patients, the overall mortality rate was 8% compared to 21% (for neurologic and non-neurologic patients) in this study.[35]