Neurologic manifestations in hospitalized patients with COVID-19 in Mexico City.
Dr. Fernando Daniel Flores-Silva 1‡, Dr. Miguel García-Grimshaw 1‡, Dr. Sergio Iván Valdés-Ferrer 1,2‡, Dra. Alma Poema Vigueras-Hernández 1, Dr. Rogelio Domínguez-Moreno 1, Dra. Dioselina Panamá Tristán-Samaniego 1, Dra. Anaclara Michel-Chávez 1, Dra. Alejandra González-Duarte 1, Dr. Felipe A. Vega-Boada 1, Dr. Isael Reyes-Melo 1, Dr. Amado Jiménez-Ruiz 3, Dr. Oswaldo Dr. Alan Chávez-Martínez 1, Dr. Daniel Rebolledo-García 1, Dr. Osvaldo Alexis Marché-Fernández 1, Dra. Samantha Sánchez-Torres 1, Dr. Guillermo García-Ramos 1, Dr. Carlos Cantú -Brito 1*, Dr. Erwin Chiquete 1*.
1 Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 2 Center for Biomedical Science, Feinstein Institute for Medical Research,Manhasset, NY, United States of America, 3 Stroke, Dementia & Heart Disease Laboratory, WesternUniversity, London, ON, Canada.
‡ These authors contributed equally to this work and merit first authorship on this work.‡ These authors contributed equally to this work and merit first authorship on this work.
Originally published / April 8, 2021 / https://doi.org/10.1371/journal.pone.0247433
The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies neurologic features at presentation and complications during the disease course. We aimed to describe the characteristics and predictors for developing in-hospital neurologic manifestations in a large cohort of hospitalized patients with COVID-19 in Mexico City.
We analyzed records from consecutive adult patients hospitalized from March 15 to June 30, 2020, with moderate to severe COVID-19 confirmed by reverse transcription real-time
polymerase chain reaction (rtRT-PCR) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurologic syndromes were actively searched by a standardized
structured questionnaire and physical examination, confirmed by neuroimaging, neurophysiology of laboratory analyses, as applicable.
We studied 1,072 cases (65% men, mean age 53.2±13 years), 71 patients had pre-existing neurologic diseases (diabetic neuropathy: 17, epilepsy: 15, history of ischemic stroke: eight, migraine: six, multiple sclerosis: one, Parkinson disease: one), and 163 (15.2%) developed a new neurologic complication. Headache (41.7%), myalgia (38.5%), dysgeusia (8%), and anosmia (7%) were the most common neurologic symptoms at hospital presentation. Delirium (13.1%), objective limb weakness (5.1%), and delayed recovery of mental status after sedation withdrawal (2.5%), were the most common new neurologic syndromes. Age, headache at presentation, preexisting neurologic disease, invasive mechanical ventilation, and neutrophil/lymphocyte ratio >9 were independent predictors of new in-hospital neurologic complications.