Neurological complications develop in hospitalised COVID-19 patients

While stroke was the most common neurological complication in hospitalised COVID-19 patients, many younger patients developed an altered mental state, new research has revealed.
The study, published today in The Lancet Psychiatry, provides valuable information needed by clinicians, researchers, and funders to inform the next steps in neuroscience research into the virus.
Concerns regarding potential neurological complications of COVID-19 are being reported, however, most published reports have been individual cases and even larger studies have been limited by geography and specialty.
Risk factors
Neurological and psychiatric complications that are believed to be caused by the virus include delirium, psychosis, catatonia and stroke.
Important questions remain, such as how common complications are, whether novel syndromes are emerging, and which people are most at risk.
To address this, the CoroNerve Studies Group, a collaboration between the universities of Newcastle, Liverpool, Southampton and UCL, developed a rapid notification case identification system across the spectrum of major UK Neuroscience Professional Bodies, representing neurology, stroke, psychiatry, and intensive care.
During three weeks of the exponential pandemic phase, the researchers identified 153 cases from across the UK who had both a new COVID-19 diagnosis and a new neurological or psychiatric diagnosis.
The median age of the patients was 71 (23-94) years. Of the 125 patients for whom complete clinical data was available, 57 (44%) suffered ischemic strokes and 39 (31%) experienced an altered mental state reflecting both neurological and psychiatric diagnoses.
Whereas 61 (82%) of cases of cerebrovascular events occurred in those over 60 years old, half of cases with an altered mental state were under 60 years old.
Dr Rhys Thomas, from Newcastle University’s Faculty of Medical Sciences, a co-author of the study, said: “Whilst stroke represents the majority of reported cases, what is most striking with our research is that there are the individuals who present with altered mental state, including delirium, psychosis and catatonia.
“These people represent the first notifications that we as CoroNerve have received and will represent the most severe of cases as most people will have been hospitalized. The project is ongoing, and we have received over 550 cases now and this will help us look at recovery and risk factors of COVID-19.”
Further research required
Larger studies are now needed to identify the broader cohort of COVID-19 patients, both in and outside of hospitals, to determine clearer estimates of the prevalence of these complications and also those at risk.
Dr Benedict Michael, who led the study for the University of Liverpool, said: “Whilst an altered mental state was being reported by some clinicians, we were surprised to identify quite so many cases, particularly in younger patients, and by the breadth of clinical syndromes ranging from brain inflammation (encephalitis) through to psychosis and catatonia.
“Clinicians should be alert to the possibility of patients with COVID-19 developing these complications and, conversely, of the possibility of COVID-19 in patients presenting with acute neurological and psychiatric syndromes.”
The CoroNerve Studies Group is supported by the Association of British Neurologists, Royal College of Psychiatrists, British Association of Stroke Physicians, British Paediatric Neurology Association, and intensive care societies, including the NeuroAnaesthesia and Critical Care Society, and the Encephalitis Society.
The researchers are supported by grants from the Medical Research Council, Wellcome, National Institute of Health Research and Academy of Medical Sciences.