Neurological disorders associated with COVID-19 in Sri Lanka
Authors: Chang Thashi , Wijeyekoon Ruwani , Keshavaraj Ajantha , Ranawaka Udaya , Senanayake Sunethra , Ratnayake Pyara , Senanayake Bimsara , Caldera Manjula C. , Pathirana Gamini , Sirisena Darshana , Wanigasinghe Jithangi , Gunatilake Saman ,   on behalf of the ASN COVID-19 Study Group, Keshavaraj A. , Ranawaka U. K. , Senanayake S. , Ratnayake P. , Senanayake B. , Caldera M. C. , Halahakoon D. , Wijesekara D. S. , Bandusena S. , Chang T. , Gunasekara H. , Gunawardhana C. , Arasalingam A. , Fernando A. , Liyanage D. S. , Pathirana G. , Rathnayake T. N. P. , Alibhoy A. T. , Weerathunga D. N. , Dissanayake A. , Gooneratne K. , Jayawardana A. , Nawasiwatte T. , Rajendiran V. T. , Rathnayake D. , Wanigasinghe J. , Arhivalaky G. J. , Branavan S. , Fernando M. J. N. , Janarthanan K. , Kariyawasam K. , Karunasena N. I. , Luke D. , Madhushanka M. K. T. , Nimesha S. N. H. , Priyacharana M. P. , Ruvanpathirana T. D. , Samarasiri DPUT , Weerasinghe S. C. 
Published: October 2023

Abstract
Background
Neurological manifestations of SARS-CoV-2 infection have been reported from many countries around the world, including the South Asian region. This surveillance study aimed to describe the spectrum of neurological disorders associated with COVID-19 in Sri Lanka.

Methods
COVID-19 patients manifesting neurological disorders one week prior and up to six weeks after infection were recruited from all the neurology centres of the government hospitals in Sri Lanka from May 2021 – May 2022. Data was collected using a structured data form that was electronically transmitted to a central repository. All patients were evaluated and managed by a neurologist. Data were analysed using simple descriptive analysis to characterise demographic and disease related variables, and simple comparisons and logistic regression were performed to analyse outcomes and their associations.

Results
One hundred and eighty-four patients with neurological manifestations associated with COVID-19 were recruited from all nine provinces in Sri Lanka. Ischaemic stroke (31%) was the commonest neurological manifestation followed by encephalopathy (13.6%), Guillain–Barre syndrome (GBS) (9.2%) and encephalitis (7.6%). Ischaemic stroke, encephalitis and encephalopathy presented within 6 days of onset of COVID-19 symptoms, whereas GBS and myelitis presented up to 10 days post onset while epilepsy and Bell palsy presented up to 20 – 40 days post onset. Haemorrhagic stroke presented either just prior to or at onset, or 10 – 25 days post onset of COVID-19 symptomatic infection. An increased frequency of children presenting with encephalitis and encephalopathy was observed during the Omicron variant predominant period.
A poor outcome (no recovery or death) was associated with supplemental oxygen requirement during admission (Odds Ratio: 12.94; p = 0.046).

Conclusions
The spectrum and frequencies of COVID-19 associated neurological disorders in Sri Lanka were similar to that reported from other countries, with strokes and encephalopathy being the commonest. Requiring supplemental oxygen during hospitalisation was associated with a poor outcome.