Neurological Manifestations of Non-Severe COVID-19-A Multidirectional Approach

Jakub Udzik; Anna Kowalczyk; Aleksandra Waszczyk; Zuzanna Nowaczyk; Andrzej Barczyszyn; Karolina Działa; Maciej Mularczyk; Małgorzata Niekrasz

doi:10.3390/brainsci13020355

Neurological Manifestations of Non-Severe COVID-19-A Multidirectional Approach

Brain Sci. 2023 Feb 18;13(2):355. doi: 10.3390/brainsci13020355.

Authors

Jakub Udzik¹, Anna Kowalczyk², Aleksandra Waszczyk³, Zuzanna Nowaczyk⁴, Andrzej Barczyszyn⁵, Karolina Działa⁵, Maciej Mularczyk⁶, Małgorzata Niekrasz²

Affiliations

¹ Department of Physiology, Pomeranian Medical University, 70-111 Szczecin, Poland.
² Department of Neurology and Cerebral Stroke, Samodzielny Publiczny Wojewódzki Szpital Zespolony, 71-455 Szczecin, Poland.
³ Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University, 71-455 Szczecin, Poland.
⁴ Neurosurgery Department, Independent Public Clinical Hospital Nr. 1, Pomeranian Medical University, 71-252 Szczecin, Poland.
⁵ Department of Radiology and Diagnostic Imaging, Samodzielny Publiczny Wojewódzki Szpital Zespolony, 71-455 Szczecin, Poland.
⁶ Department of Anatomy, Pomeranian Medical University, 70-111 Szczecin, Poland.

Abstract

COVID-19 remains a significant clinical issue worldwide, with frequent neurological manifestations. In this study, the authors combine data obtained from the patient's medical history, physical examinations, and additional test results in the pursuit of any clinically relevant connections. Fifty-eight adult patients hospitalized in the Department of Neurology and Infectiology over a five-months period were retrospectively enrolled in this study. On admission, all patients included in this study were classified as mild or moderate COVID-19 cases, according to the World Health Organization (WHO) guidelines. Laboratory tests, Electroencephalography (EEG), and Magnetic Resonance Imaging (MRI) were performed. There was no statistically significant difference in the Neutrophil-Lymphocyte Ratio (NLR), C-reactive protein (CRP), and Interleukin 6 (IL-6) in patients who reported to the hospital within a week from the symptoms' onset and in those who reported later. In total, 49.06% of patients with eligible EEG recordings presented abnormal brain activity, while 27.59% of the study population had COVID-19-associated MRI findings. EEG and MRI abnormality occurrence did not correlate with the incidence of mild neurological symptoms (headache, olfactory, and gustatory disorders) of the SARS-CoV-2 infection. In three patients in this study population, unprovoked generalized epileptic seizures occurred for the first time in their life. Non-severe SARS-CoV-2 infection causes functional and structural abnormalities within the central nervous system. Brain microhemorrhages are frequently present in non-severe COVID-19 patients. There is no significant association between mild neurological symptoms of COVID-19 and additional test abnormalities. The time from SARS-CoV-2 infection's onset to hospital admission does not seem to influence the prognostic value of CRP, IL-6, and NLR in non-severe COVID-19. Mild-to-moderate SARS-CoV-2 infection can be a trigger factor for epilepsy and epileptic seizures.

Keywords: COVID-19; COVID-19 symptoms; EEG in COVID-19; MRI in COVID-19; SARS-CoV-2 infection; brain microhemorrhages; neuro-COVID-19.

Grants and funding

This research received no external funding.