Neurological syndromes associated with COVID-19: a multicenter study in Brazil

• Published in: BMC Infectious Diseases 2025, Vol.25 (1)
• Main Authors: de Moura Brasil Matos, Aline, Gomes, Andre Borges Ferreira, Carvalho, Fernanda Martins Maia, de Oliveira, Francisco Tomaz Meneses, da Silva, Lohana Santana Almeida, Dahy, Flavia Esper, de Moura, Joao Victor Luisi, Freire, Marcela Vieira, Vidal, Jose Ernesto, Marcusso, Rosa Maria Nascimento, Smid, Jerusa, Procaci, Victor Rebelo, Massaud, Rodrigo Meireles, Von Glehn, Felipe, Casseb, Jorge, Romano, Camila Malta, de Oliveira, Augusto Cesar Penalva, Saconato, Mariana, Lindoso, Jose Angelo L, Ferrarese, Rosa PSF, Domingues, Graziela UL, Sztanjbok, Jaques, Haziot, Michel EJ, Rivero, Rene LM, Batista, Lucio NA, Rodrigues, Cleonisio L, Maia, Isaac HM, Frota, Norberto AF, Lima, Daniele M, Lima, Fabricio O, Rocha, Felipe A, Feijo, Tiago P, Tavora, Daniel GF, Mororo, Karoline F, Gonçalves, Francisco Silvanei S, Paula, Anderson V, Félix, Alvina Clara, Souza, Caio S, Romano, Thais M, Viana, Lorena S, Bruniera, Gustavo, Uehara, Marcel K, Fujino, Marcos VT, Correa, Thiago D, Barbosa, Alcino A, Hirata, Fabiana, Dangoni, Iron, Athayde, Natalia M
• Format: Report
• Language: English
• Subjects: Care and treatment; Diagnosis; Neurologic manifestations of general diseases
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-025-10504-6

Neurological manifestations associated with COVID-19 remain partially described, mainly in low- and middle-income countries where diagnostic tools are limited. To address this, we assembled medical centers in Brazil with the goal of describing neurological syndromes associated with COVID-19 during the first wave of the pandemic. From June 1st, 2020 to June 1st, 2021, non-consecutive adult patients with new onset of six neurological syndromes up to 60 days after confirmed COVID-19 were included. Data were compiled from four tertiary centers and compared with general local COVID-19 data, as well as with a previous cohort focused on vascular syndrome. 197 patients were included, presenting with vascular syndromes (81), encephalopathy (68), encephalitis (19), Guillain-Barré syndrome (13), other neuropathies (12), and myelitis (4). The incidence curve of neurocovid mirrored that of COVID-19. Neurological syndromes were present regardless of COVID-19 severity. The median time from COVID-19 to onset of neurological symptoms was 14 days, suggesting a post-infectious immune-mediated mechanism. Patients were 10 times more likely to die ([chl].sup.2 (1) = 356.55, p < 0.01, OR = 10.89) and 38 times more likely to be hospitalized than other COVID-19 patients ([chl].sup.2 (1) = 1167.9, p < 0.01, OR = 38.22). Those developing vascular syndromes patients were 3 times more likely to require ICU ([chl].sup.2 (1) = 37.12, p < 0.01, OR = 3.78) and 4 times more likely to die ([chl].sup.2 (1) = 58.808, p < 0.01, OR = 4.73) than patients with vascular syndromes due to different etiologies. Our study corroborates the association of neurological syndromes with COVID-19. The incidence correlated with local waves of COVID-19, and patients with neurocovid exhibited a higher susceptibility to adverse outcomes compared to other COVID-19 patients. Among all neurological syndromes, vascular syndromes were the most common, and their severity surpassed that of vascular syndromes not attributed to COVID-19.