Neurological reasons for consultation and hospitalization during the COVID-19 pandemic
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COVID-19
Neurological reasons for consultation and hospitalization during the COVID-19 pandemic Juan Carlos García-Moncó 1 & Antonio Cabrera-Muras 1 & Alejandra Collía-Fernández 1 & Markel Erburu-Iriarte 1 & Patricia Rodrigo-Armenteros 1 & Iñigo Oyarzun-Irazu 1 & Daniel Martínez-Condor 1 & Amaia Bilbao-González 2 & Mar Carmona-Abellán 1 & Ivan Caballero-Romero 1 & Marian Gómez-Beldarrain 3 Received: 30 July 2020 / Accepted: 8 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background COVID-19 disease affects the nervous system and led to an increase in neurological consults for patients at admission and through the period of hospitalization during the peak of the pandemic. Methods Patients with clinical and laboratory diagnosis of COVID-19 that required a neurologic consultation or those who presented with neurological problems on admission that led to a diagnosis of SARS-CoV-2 infection during a 2-month period at the peak of the pandemic were included in this study. Demographic and clinical variables were analyzed. Results Thirty-five patients were included. The presenting neurologic manifestations on admission led to the diagnosis of COVID-19 in 14 patients (40%). The most common reasons for consultation during the hospitalization period were stroke (11), encephalopathy (7), seizures (6), and neuropathies (5) followed by a miscellaneous of syncope (2), migraine (1), anosmia (1), critical illness myopathy (1), and exacerbation of residual dysarthria (1). The most common neurological disturbances were associated with severe disease except for neuropathies. Patients with encephalopathies and seizures had markedly increased D-dimer and ferritin values, even higher than stroke patients. RT-PCR was performed in 8 CSF samples and was negative in all of them. Conclusion Neurological disturbances represent a significant and severe burden in COVID-19 patients, and they can be the presenting condition that leads to the diagnosis of the viral infection in a high percentage of patients. Evidence of direct viral mechanisms was scarce, but the pathogenesis of the diverse manifestations remains enigmatic. Keywords SARS-CoV-2 . COVID-19 . Pandemic . Neurological consultation . Encephalopathy . Stroke . Encephalitis . Seizures
Introduction Neurological disturbances are an increasingly recognized part of the clinical spectrum of COVID-19 [1–11]. This has represented a diagnostic and therapeutic challenge for the attending neurologist, particularly if one considers the difficulties in
* Juan Carlos García-Moncó [email protected] 1
Department of Neurology, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Vizcaya, Spain
2
Research Unit, Basurto University Hospital, Bilbao, Vizcaya, Spain
3
Department of Neurology, Galdakao Hospital, Osakidetza Basque Health Service, Galdakao, Vizcaya, Spain
performing routine ancillary examinations in these patients in isolation with such a contagious condition. The frequency and variety of neurological disorders vary significantly depending o
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