Neurologic Manifestations of COVID-19 Linked to Higher Mortality

Background with viruses – the concept of microbiology and virology
Researchers sought to determine the neurologic phenotypes, incidence, and outcomes among adults hospitalized with COVID-19.

Neurologic manifestations among in-patients with COVID-19 were associated with increased mortality. These findings from a multicohort study were published in JAMA Network Open.

In this study, researchers analyzed data from 2 large consortia, Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) and European Academy of Neurology Neuro-COVID Registry (ENERGY). They assessed the medical histories and clinical outcomes of patients with COVID-19 with and without neurologic manifestations.

The GCS-NeuroCOVID data consisted of 2 cohorts: all patients (n=3055; 57% men; mean age, 59.9 years) with COVID-19 collected from 6 sites and patients (n=475; 55% men; mean age, 62.6 years) with neurologic manifestations from 9 sites in the US. The ENERGY cohort included patients (n=214; 62% men; mean age, 67.0 years) with COVID-19 and neurologic manifestations hospitalized at 13 sites in Europe.

The most frequently reported symptoms among the GCS-NeuroCOVID general population, neurologic population, and ENERGY cohorts were headache (38% vs 35% vs 27%) and anosmia or ageusia (28% vs 20% vs 23%), respectively. The most frequently verified neurologic signs or syndromes were acute encephalopathy (50% vs 53% vs 24%), coma (17% vs 25% vs 10%), and stroke (3% vs 19% vs 19%), respectively.

Among the GCS-NeuroCOVID general population, mortality was increased among patients who had pre-existing neurologic disorders and in-hospital neurologic manifestations.

In-hospital mortality was associated with abnormal brainstem reflexes (adjusted odds ratio [aOR], 24.28; 95% CI, 7.06-83.5; P <.001), coma (aOR, 7.70; 95% CI, 5.65-10.50; P <.001), clinically verified neurologic manifestations (aOR, 5.99; 95% CI, 4.33-8.28; P <.001), acute encephalopathy (aOR, 5.51; 95% CI, 4.01-7.57; P <.001), abnormal tone (aOR, 4.53; 95% CI, 1.40-14.60; P =.02), any neurologic manifestation (aOR, 2.48; 95% CI, 1.70-3.62; P <.001), and patients with increasing age (per 10-year increment; aOR, 1.74; 95% CI, 1.60-1.88; P <.001) or who were men (aOR, 1.66; 95% CI, 1.31-2.10; P <.001).

Clinically verified neurologic signs or syndromes were associated with a pre-existing neurologic disorder (aOR, 2.23; 95% CI, 1.80-2.75; P <.001), among men (aOR, 1.53; 95% CI, 1.30-1.82; P <.001), and with increasing age (per 10-year increment, aOR, 1.41; 95% CI, 1.34-1.48; P <.001).

This study may have been limited by the variations of care protocols across sites.

The study authors concluded that neurologic manifestations during a COVID-19 infection increased risk for in-hospital mortality. Patients who had pre-existing neurologic syndromes were at increased risk for presenting with neurologic manifestations.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.


Chou SH, Beghi E, Helbok R, et al; GCS-NeuroCOVID Consortium and ENERGY Consortium. Global incidence of neurological manifestations among patients hospitalized with COVID-19—a report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium. JAMA Netw Open. 2021;4(5):e2112131. doi:10.1001/jamanetworkopen.2021.12131