Neurological disorders associated with COVID-19 infection: An Italian multi-center cohort study (NEURO-COVID)

      Background and aims

      A variety of neurological disorders has been reported as presentations or complications of COVID-19 infection. The NEURO-COVID study is a multi-center cohort study of neurological disorders associated with COVID-19 conducted in 51 centers in Italy, sponsored by the Italian Society of Neurology (SIN).

      Methods

      We present an interim analysis of hospitalized adult patients with COVID-19 infection, defined by a positive SARS-CoV-2 test independently from clinical severity, and concomitant newly diagnosed neurological disorders. Patients were recruited from March 1, 2020 to March 26, 2021 from 18 centers and followed-up prospectively for 6 months. Follow-up data at 6 months are currently ongoing and will be available for the WCN 2021 congress.

      Results

      904 patients with confirmed COVID-19 infection and concomitant newly diagnosed neurological disorders were recruited. The median age was 68 years (IQR 56–78) and 57.5% were males. Severe acute respiratory syndrome occurred in 35.9%. The most common new neurological diagnoses were hypogeusia (21.1%), hyposmia (20.5%), acute ischemic stroke (19.6%), delirium (14.4%), headache (12.3%), cognitive impairment (11.3%), abnormal behaviour or psychosis (8.9%), seizures (5.9%), Guillain-Barrè syndrome (5.1%), severe encephalopathy with stupor or coma (3.7%), dizziness (3.0%), encephalitis (2.3%) and haemorrhagic stroke (2.3%). Overall, the onset of neurological disorders occurred during the presymptomatic-asymptomatic phase in 45.9%, during the acute respiratory illness in 37.5% and after recovery in 16.6%. In-hospital mortality was 12.2% and was mostly due to COVID-related respiratory failure (9.1%).

      Conclusions

      A wide spectrum of treatable neurological disorders are associated with COVID-19 infection. Most cases occur in late middle-aged adults with mild or severe respiratory syndrome.