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Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

##article.authors##

  • Adalberto Studart-Neto Universidade de São Paulo
  • Bruno Fukelmann Guedes Universidade de São Paulo
  • Raphael De Luca E Tuma Universidade de São Paulo
  • Antonio Edvan Camelo Filho Universidade de São Paulo
  • Gabriel Taricani Kubota Universidade de São Paulo
  • Bruno Diógenes Iepsen Universidade de São Paulo
  • Gabriela Pantaleão Moreira Universidade de São Paulo
  • Júlia Chartouni Rodrigues Universidade de São Paulo
  • Maíra Medeiros Honorato Ferrari Universidade de São Paulo
  • Rafael Bernhard Carra Universidade de São Paulo
  • Raphael Ribeiro Spera Universidade de São Paulo
  • Mariana Hiromi Manoel Oku Universidade de São Paulo
  • Sara Terrim Universidade de São Paulo
  • Cesar Castello Branco Lopes Universidade de São Paulo
  • Carlos Eduardo Borges Passos Neto Universidade de São Paulo
  • Matheus Dalben Universidade de São Paulo
  • Julia Carvalhinho Carlos De Souza Universidade de São Paulo
  • José Pedro Soares Baima Universidade de São Paulo
  • Tomás Fraga Ferreira Da Silva Universidade de São Paulo
  • Cristiane Araujo Martins Moreno Universidade de São Paulo
  • Andre Macedo Serafim Silva Universidade de São Paulo
  • Carlos Otto Heise Universidade de São Paulo
  • Rodrigo Holanda Mendonça Universidade de São Paulo
  • Ida Fortini Universidade de São Paulo
  • Jerusa Smid Universidade de São Paulo
  • Tarso Adoni Universidade de São Paulo
  • Marcia Rubia Rodrigues Gonçalves Universidade de São Paulo
  • Samira Luisa Apóstolos Pereira Universidade de São Paulo
  • Lecio Figueira Pinto Universidade de São Paulo
  • Helio Rodrigues Gomes Universidade de São Paulo
  • Edmar Zanotelli Universidade de São Paulo
  • Sonia Maria Dozzi Brucki Universidade de São Paulo
  • Adriana Bastos Conforto Universidade de São Paulo
  • Luiz Henrique Martins Castro Universidade de São Paulo
  • Ricardo Nitrini Universidade de São Paulo https://orcid.org/0000-0002-5721-1525

DOI:

https://doi.org/10.1590/0004-282X20200089

Keywords:

Coronavirus Infections, COVID-19, Neurology, Seizures, Stroke, Metabolic Encephalopathy, Neuromuscular Diseases

Abstract

Background: More than one-third of COVID-19 patients present neurological symptoms
ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing
neurological conditions may require special treatment and may be associated with worse
outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably
underrecognized. Objective: The aim of this study was to report the reasons for
requesting neurological consultations by internists and intensivists in a COVID-19-
dedicated hospital. Methods: This retrospective study was carried out at Hospital das
Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed
COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis
was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology
consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists
performed the neurological exam, assessed all available data to diagnose the
neurological condition, and requested additional tests deemed necessary. Difficult
diagnoses were established in consensus meetings. After diagnosis, neurologists were
involved in the treatment. Results: Neurological consultations were requested for 89 out
of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological
diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological
diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain
lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most
neurological consultations in a COVID-19-dedicated hospital were requested for severe
conditions that could have an impact on the outcome. First-line doctors should be able to
recognize neurological symptoms; neurologists are important members of the medical
team in COVID-19 hospital care.

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Posted

2020-07-16

Section

Health Sciences