Neurological complications in critical patients with COVID-19

Abenza-Abildúa, M. J.; Ramírez-Prieto, M. T.; Moreno-Zabaleta, R.; Arenas-Valls, N.; Salvador-Maya, M. A.; Algarra-Lucas, C.; Rojo Moreno-Arrones, B.; Sánchez-Cordón, B.; Ojeda-Ruíz de Luna, J.; Jimeno-Montero, C.; Navacerrada-Barrero, F. J.; Borrue-Fernández, C.; Malmierca-Corral, E.; Ruíz-Seco, P.; González-Ruano, P.; Palmí-Cortés, I.; Fernández-Travieso, J.; Mata-Álvarez de Santullano, M.; Almarcha-Menargues, M. L.; Gutierrez-Gutierrez, G.; Palacios Castaño, J. A.; Alonso Esteban, R.; Gonzalo-García, N.; Pérez-López, C.

Introduction We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. Patients and methods We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. Results We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P = .002; 95% CI, 4.032-6.022; OR:). Conclusions Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.