Author/Authors :
Zare Dehnavi, Ali Department of Neurology - School of Medicine - AJA University of Medical Sciences, Tehran, Iran , Salehi, Mohammadreza Infectious Diseases and Tropical Medicines Department - Tehran University of Medical Sciences, Tehran, Iran , Arab Ahmadi, Mehran Advanced Diagnostic and Interventional Radiology Research Center - Tehran University of Medical Sciences, Tehran, Iran , Asgardoon, Mohammad Hossein School of Medicine - Tehran University of Medical Sciences, Tehran, Iran , Ashrafi, Farzad Functional Neurosurgery Research Center - Shohadaye Tajrish Neurosurgical Center of Excellence - Shahid Beheshti University of Medical Sciences, Tehran, Iran , Ahmadinejad, Nasrin Advanced Diagnostic and Interventional Radiology Research Center - Tehran University of Medical Sciences, Tehran, Iran , Behkar, Atefeh School of Medicine - Tehran University of Medical Sciences, Tehran, Iran , Hamidi Farahani, Ramin Department of Infectious Disease - AJA University of Medical Sciences, Tehran, Iran , Hashemi, Hassan Advanced Diagnostic and Interventional Radiology Research Center - Tehran University of Medical Sciences, Tehran, Iran , Tafakhori, Abbas Department of Neurology - School of Medicine - Imam Khomeini Hospital - Tehran University of Medical Sciences, Tehran, Iran , Shahali, Hamze Department of Aerospace and Sub Aquatic Medicine - AJA University of Medical Sciences, Tehran, Iran , Rahmani, Mohammad Department of Neurology - School of Medicine - Imam Khomeini Hospital - Tehran University of Medical Sciences, Tehran, Iran , Ranjbar Naeini, Alireza Department of Neurology - School of Medicine - AJA University of Medical Sciences, Tehran, Iran
Abstract :
Introduction: Although neurologic involvement and neuroimaging abnormalities have been frequently identi-
fied in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of
the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clin-
ical, laboratory, and imaging characteristics. Methods: This multicenter cross-sectional study was conducted
between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sam-
pling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction
(PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay.
Results: Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe
infection). Central nervous system and psychiatric manifestations were significantly more common in severe
cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and
hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging
were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analy-
sis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and
C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients
with new neuroimaging abnormalities had a significantly higher lung CT score than those without any patho-
logic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion: Approximately 30% of the study population had
various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of
acute neuroimaging abnormalities in hospitalized COVID-19 patients.
Keywords :
COVID-19 , Neurology , Neurologic Manifestations , Neuroimaging , Tomography X-ray computed , Magnetic Resonance Imaging , Risk Factors
