More than 57% of patients hospitalized for Covid-19 have developed any neurological symptoms

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More than 57% of patients hospitalized for Covid-19 have developed any neurological symptoms. Furthermore, neurological complications were the main cause of death in 4% of those who died of coronavirus. This is reflected in the data obtained by the Spanish registry ALBACOVID, which has just been published in the journal 'Neurology'.

This registry, carried out in the month of March among all those hospitalized by Covid-19 in the province of Albacete - and which is the most extensive that has been published to date internationally, as it reviews a total of 841 patients - highlights that Compared to other international studies, patients develop more comorbidity and a higher percentage of neurological symptoms: the main study that has been carried out in China indicated that 36% of those affected had neurological symptoms, compared to 57% who registered this. I study Spanish.

"From the ALBACOVID registry, it appears that neurological manifestations are more common than previously thought in hospitalized patients with Covid-19. Furthermore, the fact that for the performance of this registry, a greater number of patients were available, compared to other studies that have been carried out in other countries, make us think that the data in this registry are the most approximate, or at least in relation to the Spanish population, "says José Miguel Lainez, president of the Spanish Society of Neurology (SEN) . "Therefore, from the SEN we recommend that health professionals keep a close neurological watch on patients affected by SARS-CoV-2 to recognize early complications from the nervous system."

Since the start of the pandemic, the SEN has been carrying out the Covid-19 Registry, with the voluntary contributions of neurologists who have detected neurological symptoms in patients affected by this virus. Although it is still in development, the most frequent neurological manifestations collected are: confusional syndrome or mild-moderate encephalopathy, stroke, anosmia / hyposmia, headaches and epilepsy. However, Spanish neurologists have also treated other, although less frequent, cases of severe encephalopathy or coma, encephalitis, polyradiculoneuropathies, movement disorders, facial paralysis or paralysis of oculomotor nerves.

"While some nonspecific symptoms such as headache or dizziness may be directly associated with virus infection, we believe that some neurological complications of Covid-19, especially the most severe ones, occur as a consequence of hyperactivation of the immune system, known as 'cytokine storm', so you can also expect autoimmune complications from the immune response, rather than from the virus itself, "explains Lainez.

According to the ALBACOVID registry, 57.4% of the patients hospitalized by Covid-19 developed some neurological symptom and in 2.5% of the cases it was some of these symptoms that led the patients to go to the Emergency Department. Among the so-called nonspecific symptoms: myalgia (17.2%), headache (14.1%) and dizziness or instability (6.1%) were mainly present in the early stages of infection . On the other hand, anosmia or loss of smell (4.9%) and dysgeusia or alteration of the sense of taste (6.2%) were symptoms that were also present in the early stages of the disease, were more frequent in cases less severe and in 60% of cases, it was the first clinical manifestation of the infection. In addition, almost 20% of those hospitalized suffered some disorder of consciousness (19.6%), although this symptom was mainly present in elderly patients with severe and advanced Covid-19. Other more severe and more specific symptoms from the field of Neurology were also recorded, such as myopathies (3.1%), dysautonomia (2.5%), cerebrovascular disease (1.7%), seizures (0.7%) and disorders of the movement (0.7%).

On the other hand, and although less frequent, the ALBACOVID registry also identified some cases of encephalitis, Guillain-Barré syndrome and optic neuritis. Likewise, 20% of the patients developed neuropsychiatric symptoms, mainly insomnia, anxiety, depression and psychosis . "In addition, in our study it is also found that obesity is a risk factor of severity above the rest, possibly because the patient with obesity has less ventilatory capacity and, on the other hand, a greater facility to respond with an excessive immune response "says Tomás Segura, one of the main managers of the ALBACOVID registry.

Other studies

Precisely on anosmia and dysgeusia, another Spanish study has also been published in the journal 'Frontiers in Public Health', carried out on 909 patients from Madrid with SARS-CoV-2 infection and with alterations in taste and smell. Strikingly, 54% of these patients had neither nasal congestion nor mucus.

Regarding headaches, another study -accepted, but still pending publication by the magazine 'Headache'- conducted in 112 Spanish health workers with SARS-CoV-2 infection who presented headaches during the course of the disease , highlights that more than 73 % of people who developed this symptom had no previous history of headache. Headache episodes, regardless of fever, occur around the third day after the onset of symptoms, worsen with physical activity or head movements, and are more acute in those with a prior history of migraine.

And with regard to cerebrovascular diseases , it should be noted that another larger study also carried out in Albacete- in 50 days and with respect to 1,683 admissions of patients with Covid-19-, which has just been published in the journal 'Brain'- highlights that a 1 4% of the admitted patients developed cerebrovascular disease: 74% of the cases corresponded to cases of ischemic strokes and 22% to hemorrhagic strokes. Likewise, a systematic review published in the journal Neurology highlights that having a history of stroke increases the risk of dying by Covid-19 three times ; and an international study, with significant Spanish participation, published in the journal 'Stroke', suggests that ischemic strokes associated with Covid-19 are more severe, lead to greater disability and higher mortality than non-Covid-19 ischemic strokes.

In recent weeks, there have been numerous studies led by teams of Spanish neurologists that have been published in the main national and international scientific publications on the neurological symptoms detected in patients with Covid-19. The Spanish Society of Neurology (SEN) has wanted to carry out a review of the main findings of these studies -mainly those that have had a greater number of patients for their performance- have been taken into account in order to determine the scope of the neurological affection among the Spanish population that has suffered from Covid-19.

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