Nervous System Involvement in Patients Hospitalized at the COVID-19 Isolation Hospital in Alexandria University, Egypt: Clinical Findings

Background Global studies have exemplified that COVID-19 has neurological manifestations. This study gives an insight to the impact of COVID-19 on the nervous system in Alexandria, Egypt and identifies predictors of severity and mortality. Methods This single centre, retrospective, observational study was conducted from August 1st, 2020 to January 31st, 2021, on patients admitted at the COVID-19 Isolation Hospital in Alexandria University, Egypt. A Neuro-COVID patient was defined as confirmed COVID-19 case presenting with one or more new onset nervous system finding. Results Out of 1073 in-patients, 352 were Neuro-COVID patients (183 [52%] females and 169 [48%] males). The mean age was 36.64 ± 18.97 years and 161 (45.7%) had comorbidities. Most common involvement was neuromusculoskeletal system (240 [68.2%]), followed by central nervous system (164 [46.6%]) and peripheral nervous system (125 [35.5%]), whereas, psychiatric disorders (4 [1.1%]) were the least common. Myalgia (215 [61.1%]); anosmia (118 [33.5%]); headache (100 [28.4%]); ageusia (80 [22.7%]); altered level of consciousness (56 [15.9%]); arthralgia (43 [12.2%]) and dizziness (12 [3.4%]) were predominant presentations. Female Neuro-COVID patients were twice as more likely to be critical than moderate (P =0.030). Critical cases with nervous system presentations manifested 12 times higher risk of death when compared to severe cases (P <0.001). Conclusions Nervous system involvement was predominant and clinically significant in COVID-19. Disease severity was identified as an independent predictor of mortality in Neuro-COVID patients.