Reader Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

We read with interest the article by Frontera et al.1 studying neurologic disorders in hospitalized COVID-19 patients in New York City. The overall prevalence of neurologic disorders among hospitalized COVID-19 patients was 13.5%. The most common neurologic symptoms were toxic/metabolic encephalopathy (309/606, 51%), stroke (84/606, 14%), seizure (74/606, 12%), and hypoxic/ischemic brain injury (65/606, 11%). In a recent study by Kremer et al.,2 correlated neurologic and neuroimaging findings of COVID-19 patients concluded that among 64 patients with neurologic symptoms who underwent brain MRI, ischemic strokes (27%) were the most common finding, followed by leptomeningeal enhancement (17%) and encephalitis (13%). Even in present study, the CSF findings (table 2) show raised protein [median 61, IQR (42–106) mg/dL], favoring intrathecal inflammation and possibility of meningitis and/or encephalitis. Although there were few cells in the CSF [2 (1–4)], in COVID-19 patients, atypical inflammatory response without CSF pleocytosis is not uncommon.3 Another possible explanation of not picking up any encephalitis or meningitis in the present study is the lesser number of brain MRI (15%) being performed. We are unable to understand the difference between stroke and hypoxic/ischemic brain injury because they were categorized separately in the current study!

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