Neurological Manifestations in Critically Ill COVID-19 Patients


Patients with COVID-19 frequently experience neurological symptoms. Headaches and dizziness are common but non-specific symptoms. Both peripheral and central nervous systems can be impacted in severe stages. We focused on the neurological manifestations of COVID-19 patients in critical care. A cohort study evaluated the acute neurological manifestations in 204 patients admitted to intensive care units (ICU) tertiary Imam Khomeini hospital complex, Tehran, Iran. Patients with positive COVID-19 tests and severe clinical symptoms in both sexes, older than 16 years, were included in the study. Two groups of patients with positive or negative neurologic complications were compared by chi-square or Fisher exact test for categorical variables. The differences in continuous variables between the two groups were investigated using an independent sample t-test. The Kolmogorov-Simonov test was used to verify the normality assumption. A P less than 0.05 was considered statistically significant. The study included 204 individuals (130 males and 74 females) out of 270 ICU patients. Ninety (44.1%) patients were discharged, while 114 (55.9%) died. Overall, 17 (8.3%) patients had neurological complications, while 187 (91%) did not (P=0.005). The two groups did not have significantly different mean age (P=0.325) and sex (P=.793). The ventilation support was significantly different in the two groups (P=0.002). The death group had a higher incidence of loss of consciousness (P=0.003). COVID-19 causes neurological symptoms, especially during the inflammatory phase, and clinicians should be alert for neurological issues.

1. Wang ZH, Shu C, Ran X, Xie CH, Zhang L. Critically Ill patients with coronavirus disease 2019 in a designated ICU: clinical Features and Predictors for mortality. Risk Manag Healthc Policy 2020;13:833-45.
2. Liu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med 2020;38:2074-80.
3. Liu X, Zhou H, Zhou Y, Wu X, Zhao Y, Lu Y, et al. Risk factors associated with disease severity and length of hospital stay in COVID-19 patients. J Infec 2020;81:e95-7.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
5. Wang F, Hou H, Wang T, Luo Y, Tang G, Wu S, et al. Establishing a model for predicting the outcome of COVID-19 based on the combination of laboratory tests. Travel Med Infect Dis 2020;36:101782.
6. Li Y, Zhao K, Wei H, Chen W, Wang W, Jia L, et al. Dynamic relationship between D‐dimer and COVID‐19 severity. Br J Hematol 2020;190:e24-7.
7. Wu MY, Yao L, Wang Y, Zhu XY, Wang XF, Tang PJ, et al. Clinical evaluation of potential usefulness of serum lactate dehydrogenase (LDH) in 2019 novel coronavirus (COVID-19) pneumonia. Respi Res 2020;21:1-6.
8. Krijnen EA, Matthijs SPP, Tjan DHT. Neurological complications in COVID-19 patients admitted to a general ICU in the Netherlands. Neth J Crit Care 2021;2:96-101.
9. Valencia-Enciso N, Ortiz-Pereira M, Zafra-Sierra MP, Espinel-Gómez L, Bayona H. Time of Stroke Onset in Coronavirus Disease 2019 Patients Around the Globe: A Systematic Review and Analysis. J Stroke Cerebrovasc Dis 2020;29:105325.
10. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-90.
11. Khatoon F, Prasad K, Kumar V. Neurological manifestations of COVID-19: available evidences and a new paradigm. J Neurovirol 2020;26:619-30.
12. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Horoi M, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 2020;277:2251-61.
13. Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARSCoV-2 infection: causality or coincidence? Lancet Neurol 2020;19:383-4.
14. Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol 2020;70:311-22.
15. Vinayagam S, Sattu K. SARS-CoV-2 and coagulation disorders in different organs. Life Sci 2020;260:118431.
16. Shi K, Tian DC, Li ZG, Ducruet AF, Lawton MT, Shi FD. Global brain inflammation in stroke. Lancet Neurol 2019;18:1058-66.
17. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145-7.
18. Ashrafi F, Ommi D, Zali A, Khani S, Soheili A, Arab-Ahmadi M, et al. Neurological Manifestations and their Correlated Factors in COVID-19 Patients; a Cross-Sectional Study. Arch Acad Emerg Med 2021;9:e34
19. Koh JS, De Silva DA, Quek AML, Chiew HJ, Tu TM, Seet CYH, et al. Neurology of COVID-19 in Singapore. J Neurol Sci 2020;418:117118.
20. Notz Q, Lotz C, Herrmann J, Vogt M, Schlesinger T, Kredel M, et al. Severe neurological complications in critically ill COVID 19 patients. J Neurol 2021;268:1576-9.
21. Tandon M, Kataria S, Patel J, Mehta TR, Daimee M, Patel V, et al. A Comprehensive Systematic Review of CSF Analysis That Defines Neurological Manifestations of COVID-19. Int J Infect Dis 2021;104:390-7.
IssueVol 60, No 4 (2022) QRcode
Coronavirus disease 2019 (COVID-19) Neurology Manifestations Critical care

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Amoozadeh L, Beigmohammadi M. Neurological Manifestations in Critically Ill COVID-19 Patients. Acta Med Iran. 2022;60(4):210-214.