Neurological Manifestations and Long-term Sequelae in Hospitalized Patients with COVID-19.

Ishiyama, Hiroyuki; Ishii, Junko; Yoshimura, Hajime; Tsunogae, Marie; Fujiwara, Satoru; Hiya, Satomi; Inui, Ryoma; Shiomi, Yuma; Nakazawa, Shinsaku; Kimura, Masamune; Kuroda, Takehito; Murakami, Yasutaka; Maekawa, Kota; Ohara, Nobuyuki; Kohara, Nobuo; Kawamoto, Michi

Objective Various neurological manifestations have been increasingly reported in coronavirus disease 2019 (COVID-19). We determined the neurological features and long-term sequelae in hospitalized COVID-19 patients. Methods We retrospectively studied 95 consecutive hospitalized patients with COVID-19 between March 1 and May 13, 2020. Acute neurological presentations (within two weeks of the symptom onset of COVID-19) were compared between 60 non-severe and 35 severely infected patients who required high-flow oxygen. In the 12 ventilated patients (the most severe group), we evaluated neurological complications during admission, subacute neurological presentations, and neurological sequelae (51 and 137 days from the onset [median], respectively). Results Of the 95 patients (mean age 53 years old; 40% women), 63% had acute neurological presentations, with an increased prevalence in cases of severe infections (83% vs. 52%, p<0.001). Impaired consciousness and limb weakness were more frequent in severe patients than in non-severe ones (0% vs. 49%; p<0.001, and 0% vs. 54%; p<0.001, respectively). In the most severe group (mean age 72 years old; 42% women), 83% of patients had neurological complications (cerebrovascular disease [17%], encephalopathy [82%], and neuropathy [55%]), and 92% had subacute neurological presentations (impaired consciousness [17%], higher brain dysfunction [82%], limb weakness [75%], and tremor [58%]). Neurological sequelae were found in 83% of cases, including higher brain dysfunction (73%), limb weakness (50%), and tremor (58%). Conclusions Neurological manifestations are common in COVID-19, with the possibility of long-lasting sequelae.