Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Neurological Manifestations and Long-term Sequelae in Hospitalized Patients with COVID-19
Hiroyuki IshiyamaJunko IshiiHajime YoshimuraMarie TsunogaeSatoru FujiwaraSatomi HiyaRyoma InuiYuma ShiomiShinsaku NakazawaMasamune KimuraTakehito KurodaYasutaka MurakamiKota MaekawaNobuyuki OharaNobuo KoharaMichi Kawamoto
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2021 Volume 60 Issue 22 Pages 3559-3567


Objective Various neurological manifestations have been increasingly reported in coronavirus disease 2019 (COVID-19). We determined the neurological features and long-term sequelae in hospitalized COVID-19 patients.

Methods We retrospectively studied 95 consecutive hospitalized patients with COVID-19 between March 1 and May 13, 2020. Acute neurological presentations (within two weeks of the symptom onset of COVID-19) were compared between 60 non-severe and 35 severely infected patients who required high-flow oxygen. In the 12 ventilated patients (the most severe group), we evaluated neurological complications during admission, subacute neurological presentations, and neurological sequelae (51 and 137 days from the onset [median], respectively).

Results Of the 95 patients (mean age 53 years old; 40% women), 63% had acute neurological presentations, with an increased prevalence in cases of severe infections (83% vs. 52%, p<0.001). Impaired consciousness and limb weakness were more frequent in severe patients than in non-severe ones (0% vs. 49%; p<0.001, and 0% vs. 54%; p<0.001, respectively). In the most severe group (mean age 72 years old; 42% women), 83% of patients had neurological complications [cerebrovascular disease (17%), encephalopathy (82%), and neuropathy (55%)], and 92% had subacute neurological presentations [impaired consciousness (17%), higher brain dysfunction (82%), limb weakness (75%), and tremor (58%)]. Neurological sequelae were found in 83% of cases, including higher brain dysfunction (73%), limb weakness (50%), and tremor (58%).

Conclusions Neurological manifestations are common in COVID-19, with the possibility of long-lasting sequelae.

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© 2021 by The Japanese Society of Internal Medicine
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