The present study was designed to investigate the relationship between medical comorbidities and neurological manifestations in a series of 484 consecutive patients with COVID-19.

Medical comorbidities and neurologic manifestations are associated with COVID-19, though the specific relationships between comorbid conditions and neurologic manifestations of COVID-19 remain unclear.

We reviewed medical comorbidities and COVID-19-related central nervous system (CNS) and peripheral nervous system (PNS) symptoms in 484 consecutive patients hospitalized with COVID-19.

Neurological manifestations were seen in 345 of 484 COVID-19 patients (71%).  CNS manifestations included headaches (107 patients, 22%), altered mental status (92 patients, 19%), dizziness (40 patients, 8%), gait imbalance (23 patients, 5 %), strokes (4 patients, <1%), and seizures (2 patients, <1%). PNS manifestations included myalgia (151 patients, 31%), hypogeusia (38 patients, 8%), hyposmia (27 patients, 6%), critical illness myopathy (9 patients, 2%), visual disturbance (6 patients, 1%), rhabdomyolysis (4 patients, <1%) and nerve pain (1 patient, <1%). There were 153 patients (32%) with CNS symptoms, 98 patients with PNS symptoms (20%), and 94 patients (19%) with combined CNS and PNS manifestations. Comorbidities such as cardiac disease (108 patients, 22%), dementia (83 patients, 17%), hypertension (76 patients, 16%), and COPD (61 patients, 13%) were significantly associated with CNS manifestations. No comorbidities were significantly associated with PNS manifestations.

Neurological manifestations are common in COVID-19 patients. The most common CNS manifestations were headache and altered mental status and the most common PNS manifestation was myalgia. Comorbid conditions such as cardiac disease, dementia, hypertension, and COPD were more prevalent in patients with CNS manifestations. Providers should be vigilant about the possible emergence of CNS manifestations in COVID-19 patients with these comorbid conditions.