Coronavirus infections are known to have neuro invasive potential with consequent neuropsychiatric manifestations. Since early recognition and prompt management of neuropsychiatric manifestations in these patients have a potential to decrease overall morbidity and mortality.We analyzed COVID-19 adult patients from January 20, 2020 to June 10th, 2020. 40,469 patients were diagnosed with COVID-19 among whom 9086 patients had neuropsychiatric manifestations. 

Corona Virus 2 is a highly pathogenic coronavirus identified as causing mild to severe symptoms involving Respiratory, GI, Cardiac and tend to have neuroinvasive potential. In the largest study thus far, Mao et al reported a case series of 214 patients, where approximately one-third of these patients had neurological symptoms including stroke, encephalopathy and myopathy. We studied, 40,469 COVID-19 patients, our aim is to describe the demographics, neurological manifestations, and complications of COVID-19.

De-identified COVID-19 patient data was extracted using TriNetX from Jan 20, 2020 to June 10 2020. Study population included patients with age 18 years or older with a positive diagnosis of COVID-19

Of the total 40,469 COVID-19 patients, (22.5%) patients had neuropsychiatric manifestations. The most common neurologic manifestations included headaches (3.7%) and sleep disorders (3.4%). Other manifestations were encephalopathy (2.3%), myalgia (2.0%), pain (1.8%), loss of taste and smell (1.2%), stroke and transient ischemic attack (TIA) (1.0%), dizziness (0.9%), extrapyramidal and movement disorders (0.7%), seizures (0.6%), polyneuropathy (0.6%), and nerve root and plexus disorders (0.4%).

Common psychiatric manifestations included anxiety and other related disorders (4.6%), mood disorders (3.8%). Less than 1% of all psychiatric manifestations included emotional state symptoms and signs (0.8%), suicidal ideation (0.2%).

Potential mechanisms of neuropsychiatric manifestation include direct CNS infiltration, cytokine network dysregulation, peripheral immune cell transmigration, and post-infectious autoimmune response. Clinicians need to be aware of these manifestations in COVID-19 patients, given the morbidity and mortality of neuropsychiatric involvement.