Open Access

Nina Natascha Kleineberg, Samuel Knauss, Eileen Gülke, Hans O. Pinnschmidt, Carolin Ellen Marianne Jakob, Paul Lingor, Kerstin Hellwig, Achim Berthele, Günter Höglinger, Gereon R. Fink, Matthias Endres, Christian Gerloff, Christine Klein, Melanie Stecher, Annika Claßen, Siegbert Rieg, Stefan Borgmann, Frank Hanses, Maria Madeleine Rüthrich, Martin Hower, Lukas Tometten, Martina Maria Haselberger, Christiane Piepel, Uta Merle, Sebastian Conrad Johannes Dolff, Christian Degenhardt, Björn-Erik Ole Jensen, Maria J. G. T. Vehreschild, Johanna Erber, Christiana Franke, Clemens Warnke

• Background and purpose: During acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry. Methods: We analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results: A total of 6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20–1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07–1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. Conclusion: Our data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.