Case series/case reports (Indigo)
During acute COVID-19 neurological signs, symptoms and complications occur. The real-world data from multinational registries may inform on the clinical relevance. In this study the authors analyzed COVID-19 patients of 127 centers, diagnosed between 01/2020 and 02/2021, and registered at the European multinational LEOSS registry ‘Lean European Open Survey on SARS-Infected Patients’. The effects of neurological implications on outcome were studied by multivariate logistic regression.
6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, hereof, 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB, 2.2%). ICB peaked in the critical disease phase (5%) and associated with the administration of anticoagulation and extracorporeal membrane oxygenation. Excessive tiredness (OR 1.42, 95% CI 1.20-1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07-1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. The authors concluded that their data of mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICBs in critical COVID-19 are associated with therapeutic interventions, such as anticoagulation and extracorporeal membrane oxygenation, and thus may rather be an indirect complication of a life-threatening systemic viral infection.
Kleineberg NN, Knauss S, Gülke E, Pinnschmidt HO, Jakob CEM, Lingor P, Hellwig K, Berthele A, Höglinger G, Fink GR, Endres M, Gerloff C, Klein C, Stecher M, Classen AY, Rieg S, Borgmann S, Hanses F, Rüthrich MM, Hower M, Tometten L, Haselberger M, Piepel C, Merle U, Dolff S, Degenhardt C, Jensen BO, Vehreschild MJGT, Erber J, Franke C, Warnke C; LEOSS Study Group. Neurological symptoms and complications in predominantly hospitalized COVID-19 patients – results of the European multinational LEOSS registry. Eur J Neurol. 2021 Aug 19. doi: 10.1111/ene.15072.