Clinical Findings in Patients with Nervous System Involvement Hospitalized at the COVID-19 Isolation Hospital in Alexandria University, Egypt: A Case Control Study

Background: Global studies have exemplified that COVID-19 has neurological manifestations. This study gives an insight to the impact of COVID-19 on the nervous system in Alexandria, Egypt and identifies predictors of severity and mortality. Methods: This single centre, case-control study was conducted from August 1 st , 2020 to January 31 st , 2021, on patients admitted at the COVID-19 Isolation Hospital in Alexandria University, Egypt. A Neuro-COVID patient was defined as confirmed COVID-19 case presenting with one or more new onset nervous system finding. Results: Out of 1073 in-patients, 352 were Neuro-COVID patients (183 [52%] females and 169 [48%] males). The mean age was 36.64 ± 18.97 years and 161 (45.7%) had comorbidities. Most common involvement was neuromusculoskeletal system (240 [68.2%]), followed by central nervous system (164 [46.6%]) and peripheral nervous system (125 [35.5%]), whereas, psychiatric disorders (4 [1.1%]) were the least common. Myalgia (215 [61.1%]); anosmia (118 [33.5%]); headache (100 [28.4%]); ageusia (80 [22.7%]); altered level of consciousness (56 [15.9%]); arthralgia (43 [12.2%]) and dizziness (12 [3.4%]) were predominant presentations. Female Neuro-COVID patients were twice as more likely to be critical than moderate ( P =0.030). Critical cases with nervous system presentations manifested 12 times higher risk of death when compared to severe cases ( P <0.001). Conclusions: Nervous system involvement was predominant and clinically significant in COVID-19. Disease severity was identified as an independent predictor of mortality in Neuro-COVID patients.