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December 09, 2020Research

Neurologic findings among inpatients with COVID-19 at a safety-net US hospital

View ORCID ProfilePria Anand, Lan Zhou, Nahid Bhadelia, View ORCID ProfileDavidson H. Hamer, David M. Greer, Anna M. Cervantes-Arslanian
First published December 9, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000001031
Pria Anand
Boston University Medical Center (PA); and Boston University School of Medicine (LZ, NB, DHH, DMG, AMC-A), MA.
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  • ORCID record for Pria Anand
Lan Zhou
Boston University Medical Center (PA); and Boston University School of Medicine (LZ, NB, DHH, DMG, AMC-A), MA.
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Nahid Bhadelia
Boston University Medical Center (PA); and Boston University School of Medicine (LZ, NB, DHH, DMG, AMC-A), MA.
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Davidson H. Hamer
Boston University Medical Center (PA); and Boston University School of Medicine (LZ, NB, DHH, DMG, AMC-A), MA.
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David M. Greer
Boston University Medical Center (PA); and Boston University School of Medicine (LZ, NB, DHH, DMG, AMC-A), MA.
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Anna M. Cervantes-Arslanian
Boston University Medical Center (PA); and Boston University School of Medicine (LZ, NB, DHH, DMG, AMC-A), MA.
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Neurologic findings among inpatients with COVID-19 at a safety-net US hospital
Pria Anand, Lan Zhou, Nahid Bhadelia, Davidson H. Hamer, David M. Greer, Anna M. Cervantes-Arslanian
Neurol Clin Pract Dec 2020, 10.1212/CPJ.0000000000001031; DOI: 10.1212/CPJ.0000000000001031

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Abstract

Objective To characterize the breadth of neurologic findings associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a diverse group of inpatients at an urban, safety-net US medical center.

Methods Patients were identified through an electronic medical record review from April 15, 2020, until July 1, 2020, at a large safety-net hospital in Boston, MA, caring primarily for underserved, low-income, and elderly patients. All hospitalized adult patients with positive nasopharyngeal swab or respiratory PCR testing for SARS-CoV-2 during their hospitalization or in the 30 days prior to admission who received an inpatient neurologic or neurocritical care consultation or admission during the study period were enrolled.

Results Seventy-four patients were identified (42/57% male, median age 64 years). The majority of patients self-identified as Black or African-American (38, 51%). The most common neurologic symptoms at presentation to the hospital included altered mental status (39, 53%), fatigue (18, 24%), and headache (18, 18%). Fifteen patients had ischemic strokes (20%). There were 10 in-hospital mortalities, with moderately severe disability among survivors at discharge (14%, median modified Rankin Scale score of 4).

Conclusions Neurologic findings spanned inflammatory, vascular pathologies, sequelae of critical illness and metabolic derangements, possible direct involvement of the nervous system by SARS-CoV-2, and exacerbation of underlying neurologic conditions, highlighting a broad range of possible etiologies of neurologic complications in patients with coronavirus disease 2019 (COVID-19). Further studies are needed to characterize the infectious and post-infectious neurologic complications of COVID-19 in diverse patient populations.

  • Received August 12, 2020.
  • Accepted November 2, 2020.
  • © 2020 American Academy of Neurology

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