Frequency and burden of neurological manifestations in hospitalized patients with COVID-19: findings from a large Brazilian cohort
Authors: Marcolino Milena Soriano , Anschau Fernando , Kopittke Luciane , Pires Magda Carvalho , Barbosa Izabela Guimarães , Pereira Daniella Nunes , Melo Renata Brant de Souza , Assunção Luís Fernando Israel , Costa André Soares de Moura , Nogueira Matheus Carvalho Alves , Duani Helena , Martins Karina Paula Medeiros Prado , Moreira Leila Beltrami , Silva Carla Thais Cândida Alves da , de Oliveira Neimy Ramos , Ziegelmann Patricia Klarmann , Júnior Milton Henriques Guimarães , Lima Mauro Oscar Soares de Souza , Francisco Saionara Cristina , Menezes Luanna Silva Monteiro , Oliveira Talita Fischer , Souza Maíra Dias , Farace Bárbara Lopes , Cimini Christiane Corrêa Rodrigues , Maurílio Amanda de Oliveira , Guimarães Silvana Mangeon Mereilles , Araújo Silvia Ferreira , Nascimento Guilherme Fagundes , Silveira Daniel Vitório , Ruschel Karen Brasil , de Oliveira Thainara Conceição , Schwarzbold Alexandre Vargas , Nasi Luiz Antonio , Floriani Maiara Anschau , Santos Veridiana Baldon dos , Ramos Carolina Marques , de Alvarenga Joice Coutinho , Scotton Ana Luiza Bahia Alves , Manenti Euler Roberto Fernandes , Crestani Gabriela Petry , Batista Joana d’Arc Lyra , Ponce Daniela , Machado-Rugolo Juliana , Bezerra Adriana Falangola Benjamin , Martelli Petrônio José de Lima , Vianna Heloisa Reniers , de Castro Luís César , Medeiros Cássia Regina Gotler , Vietta Giovanna Grunewald , Pereira Elayne Crestani , Chatkin José Miguel , de Godoy Mariana Frizzo , Teixeira Antonio Lucio 
Published: January 2022

Background

Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection in the Brazilian population and its association with patient outcomes, such as in-hospital mortality.
Methods

This study is part of the Brazilian COVID-19 Registry, a multicentric COVID-19 cohort, including data from 37 Brazilian hospitals. For the analysis, patients were grouped according to the presence of self-reported vs. clinically-diagnosed neurological manifestations and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital, and whether or not patients ha neurological underlying disease.
Results

From 7,232 hospitalized patients with COVID-19, 27.8% presented self-reported neurological manifestations, 9.9% were diagnosed with a clinically-defined neurological syndrome and 1.2% did not show any neurological symptoms. In patients with self-reported symptoms, the most common ones were headache (19.3%), ageusia (10.4%) and anosmia (7.4%). Meanwhile, in the group with clinically-defined neurological syndromes, acute encephalopathy was the most common diagnosis (10.5%), followed by coma (0.6%1) and seizures (0.4%). Men and younger patients were more likely to self-report neurological symptoms, while women and older patients were more likely to develop a neurological syndrome. Patients with clinically-defined neurological syndromes presented a higher prevalence of comorbidities, as well as lower oxygen saturation and blood pressure at hospital admission. In the paired analysis, it was observed that patients with clinically-defined neurological syndromes were more likely to require ICU admission (46.9 vs. 37.9%), mechanical ventilation (33.4 vs. 28.2%), to develop acute heart failure (5.1 vs. 3.0%, p=0.037) and to die (40.7 vs. 32.3%, p<0.001) when compared to controls.
Conclusion

Neurological manifestations are an important cause of morbidity in COVID-19 patients. More specifically, patients with clinically defined neurological syndromes presented a poorer prognosis for the disease when compared to matched controls.