Neurological manifestations of COVID-19 in adults and children
Sung‐Min Cho, Nicole White, Lavienraj Premraj, Denise Battaglini, Jonathon P. Fanning, Jacky Y. Suen, Gianluigi Li Bassi, John F. Fraser, Chiara Robba, Matthew Griffee, Bhagteshwar Singh, gt Barbara Wanjiru Citarella, Laura Merson, Tom Solomon, David Thomson, Ali Abbas, Nurul Najmee Abdulkadir, Ryuzo Abe, Laurent Abel, Lara Absil, Subhash Prasad Acharya, Andrew Acker, Diana Adrião, Saleh Al Ageel, Shakeel Ahmed, Kate Ainscough, Tharwat Aisa, Ali Ait Hssain, Younes Ait Tamlihat, Takako Akimoto, Ernita Akmal, Razi Alalqam, Tala Al-dabbous, Senthilkumar Alegesan, Cynthia Alegre, Beatrice Alex, Kévin Alexandre, Abdulrahman Al‐Fares, Huda Alfoudri, Imran Ali, Naseem Ali Shah, Kazali Enagnon Alidjnou, Jeffrey Aliudin, Qabas Alkhafajee, Clotilde Allavena, Nathalie Allou, Aneela Altaf, João Alves, Rita de Cássia Loiola Alves, João Melo Alves, Maria João Amaral, Nur Amira, Phoebe Ampaw, Roberto Andini, Claire Andréjak, Andrea Angheben, François Angoulvant, Séverine Ansart, Sivanesen Anthonidass, Massimo Antonelli, Carlos Alexandre Antunes de Brito, Ardiyan Apriyana, Irene Aragao, Francisco Arancibia, Carolline Araujo, Antonio Arcadipane, Patrick Archambault, Lukas Arenz, Jean‐Benoît Arlet, Christel Arnold-Day, Lovkesh Arora, Rakesh C. Arora, Élise Artaud-Macari, Diptesh Aryal, Ángel Asensio, Muhammad Ashraf, Namra Asif, Mohammad Asim, Jean‐Baptiste Assié, Amirul Asyraf, Anika Atique, AM Udara Lakshan Attanyake, Johann Auchabie, Hugues Aumaître, Adrien Auvet, Laurène Azemar, Cécile Azoulay, Benjamin Bach, Delphine Bachelet, C. Badr, Nadia Baig, J. Kenneth Baillie, Erica Bak, Agamemnon Bakakos, Nazreen Abu Bakar, Andriy Bal, Mohanaprasanth Balakrishnan, Valeria Balan, Firouzé Bani‐Sadr, Renata Barbalho
Abstract
Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.