Neurological Manifestations of COVID-19 Infection Treated within the Intensive Care Units During the Pandemic Surge in NYC

Background: COVID-19 resulted in a worldwide pandemic that at the time of this writing resulted in over 200,000 deaths within the United States. During the pandemic surge in New York City, NY, a number of military Medical Corps (MC) and Nurse Corps (NC) providers were mobilized in direct support of critical care capabilities through expansion intensive care units. In the course of the deployment, high rates of neurological-related manifestations associated with COVID-19 infection were directly observed by our military provider teams which will be described and supporting literature highlighted.Case ReportExperiences of a group of mobilized providers including anesthesiologists, neurosurgeons, and other physician specialists were integrated as attending intensive care unit providers as part of the Navy Medicine Support Team (NMST) during the Federal Emergency Management Agency (FEMA) and Department of Defense (DoD) collective response – i.e. Operation Gotham. Various neurological manifestations diagnosed in patients suffering from COVID-19 infection were identified and are reported to illustrate some of the unique considerations in the care of these critically ill patients. The neurological manifestations of COVID-19 varied in presentation and severity. Cerebral vascular injuries documented included strokes, iatrogenic intraparenchymal hemorrhage, hypoxic-related changes and sequalae, as well as acquired diseases secondary to delayed treatment of other primary neurologic disease states. Hypercoagulable and inflammatory markers (d-dimer, CRP, etc) were commonly elevated, and anticoagulation became a key factor in disease treatment and to help mitigate the downstream neurologic sequalae associated with this disease.ConclusionPatients suffering from COVID-19 infection may suffer severe end organ neurologic compromise that should be directly acknowledged and addressed in both the initial and long-term intensive care unit setting. Familiarity and integration of the latest stroke intervention criteria combined with best possible neurologic examination is critical in the medical management and treatment of these patients. Further investigation is warranted with additional studies delving into the pathophysiologic, radiographic, and clinical levels of COVID-19 infection and manifestations.