Can J Neurol Sci . Neurological Presentations in Patients with COVID-19 in Cytokine Storm

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Can J Neurol Sci


. 2021 Oct 29;1-7.
doi: 10.1017/cjn.2021.247. Online ahead of print.
Neurological Presentations in Patients with COVID-19 in Cytokine Storm


Gorkem Tutal Gursoy ¹ , Hatice Yuksel ¹ , Inci Mulkem Simsek ¹ , Saniye Oral ¹ , Fadime Erdogan Kucukdagli ¹ , Ayberk Karaman ² , Esragul Akinci ³ , Aliye Bastug ³ , Hatice Rahmet Guner ³ , Hesna Bektas ¹



Affiliations

• PMID: 34866562
• DOI: 10.1017/cjn.2021.247

Abstract

Background: Coronavirus disease 2019 (COVID-19) infection causes a wide variety of neurological disorders by affecting both central and peripheral nervous systems. The cytokine storm (CS) has been blamed for the development of severe neurological disorders in COVID-19. However, the relationship between COVID-19 CS and neurological manifestations has not been adequately studied. Thus, we aimed to investigate the neurological presentations in patients with COVID-19 CS.
Methods: The study population consisted of hospitalized moderate-to-severe COVID-19 patients. It was divided into two groups CS (36 patients, 29.3%) and non-CS (87 patients, 70.7%) based on significant clinical symptoms, elevated inflammatory marker levels, radiological findings, and interleukin-6 levels (IL-6).
Results: The three most common neurological symptoms in the CS group were altered level of consciousness, headache, and unsteadiness. Altered level of consciousness was higher in the CS group (69.4%) than the non-CS group (25.3%) (p:0.001). The frequency of headache was comparable in both groups (p:0.186). The number of patients requiring intensive care unit and intubation was higher in the CS group (p:0.005 and p:0.001). The mortality rate in the CS group (38.9%) was higher than the non-CS group (8.0%) (p:0.001). IL-6, CRP, ferritin, neutrophil-lymphocyte ratio, procalcitonin, and D-dimer levels were higher in the CS group (for all p:0.001) while lymphocyte count was lower (p:0.003).
Conclusion: The most common neurological presentation in patients with CS was altered level of consciousness. The presence of CS was an independent risk factor for high mortality.

Keywords: Altered level of consciousness; COVID-19; Cytokine storm; Interleukin-6; Neurological disorders.