Open AccessNeurologic manifestations in hospitalized patients with COVID-19 in Mexico City
Author(s) -
Fernando Flores-Silva,
Miguel GarcíaGrimshaw,
Sergio Iván ValdésFerrer,
Alma Vigueras-Hernández,
Rogelio Domínguez-Moreno,
Dioselina Panamá Tristán-Samaniego,
Anaclara Michel-Chávez,
Alejandra GonzálezDuarte,
Felipe Vega-Boada,
Isael Reyes-Melo,
Amado JiménezRuiz,
Oswaldo Alan Chávez-Martínez,
Daniel Rebolledo-García,
Osvaldo Alexis Marché-Fernández,
Samantha Sánchez-Torres,
Guillermo GarcíaRamos,
Carlos Cantú-Brito,
Erwin Chiquete
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0247433
Subject(s) - medicine , dysgeusia , anosmia , myalgia , pediatrics , delirium , complication , stroke (engine) , disease , intensive care medicine , covid-19 , infectious disease (medical specialty) , adverse effect , mechanical engineering , engineering
Background The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies neurologic features at presentation and complications during the disease course. We aimed to describe the characteristics and predictors for developing in-hospital neurologic manifestations in a large cohort of hospitalized patients with COVID-19 in Mexico City. Methods We analyzed records from consecutive adult patients hospitalized from March 15 to June 30, 2020, with moderate to severe COVID-19 confirmed by reverse transcription real-time polymerase chain reaction (rtRT-PCR) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurologic syndromes were actively searched by a standardized structured questionnaire and physical examination, confirmed by neuroimaging, neurophysiology of laboratory analyses, as applicable. Results We studied 1,072 cases (65% men, mean age 53.2±13 years), 71 patients had pre-existing neurologic diseases (diabetic neuropathy: 17, epilepsy: 15, history of ischemic stroke: eight, migraine: six, multiple sclerosis: one, Parkinson disease: one), and 163 (15.2%) developed a new neurologic complication. Headache (41.7%), myalgia (38.5%), dysgeusia (8%), and anosmia (7%) were the most common neurologic symptoms at hospital presentation. Delirium (13.1%), objective limb weakness (5.1%), and delayed recovery of mental status after sedation withdrawal (2.5%), were the most common new neurologic syndromes. Age, headache at presentation, preexisting neurologic disease, invasive mechanical ventilation, and neutrophil/lymphocyte ratio ≥9 were independent predictors of new in-hospital neurologic complications. Conclusions Even after excluding initial clinical features and pre-existing comorbidities, new neurologic complications in hospitalized patients with COVID-19 are frequent and can be predicted from clinical information at hospital admission.