Clinical, Laboratory and Imaging Characteristics of Hospitalized COVID-19 Patients with Neurologic Involvement; a Cross-Sectional Study

• Published in: Archives of academic emergency medicine 2022-01, Vol.10 (1), p.e10-e10
• Main Authors: Zare Dehnavi, Ali, Salehi, Mohammadreza, Arab Ahmadi, Mehran, Asgardoon, Mohammad Hossein, Ashrafi, Farzad, Ahmadinejad, Nasrin, Behkar, Atefeh, Hamidi Farahani, Ramin, Hashemi, Hassan, Tafakhori, Abbas, Shahali, Hamze, Rahmani, Mohammad, Ranjbar Naeini, Alireza
• Format: Article
• Language: English
• Subjects: Chest CT; COVID-19; CT severity score; Neuroimaging; Neurologic Manifestations; Neurology
• ISSN: 2645-4904
• DOI: 10.22037/aaem.v10i1.1507

Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.