Neurological Syndromes Associated with COVID-19 in Brazil – The NeurocovBR Cohort
Aline Matos1, Fernanda Maia1, Francisco Oliveira2, Jose Vidal3, Rodrigo Massaud4, Felipe Von Glehn Silva5, Jorge Casseb1, Augusto Oliveira3, Camila Romano1
1Universidade de Sao Paulo, 2Irmandade Santa Casa de Misericordia, 3Instituto de Infectologia Emilio Ribas, 4Hospital Israelita Albert Einstein, 5University of Brasilia – School of Medicine
Objective:
To characterize emerging neurological manifestations during the SARS-CoV-2 pandemic in Brazil. 
Background:

At the onset of the SARS-CoV-2 pandemic, it was questioned whether neurological syndromes (NS) could emerge with the new virus. Medical literature supported this by replicating occurrences from past viral outbreaks, suggesting increased morbidity and mortality risks. We assembled the NeurocovBR study group, comprising four neurological reference centers and a robust virology laboratory. Sites were located in two COVID-19 hotspot states. Here, we present the clinical and epidemiological characteristics of this cohort.

Design/Methods:
From June 2020 to June 2021, adults presenting NS within 60 days of confirmed SARS-CoV-2 infection were included. Data were compared with general COVID-19 data and a pre-pandemic vascular syndrome cohort. We used chi-square for categorical data and non-parametric tests for continuous variables.
Results:
A total of 197 patients were included, presenting mainly with vascular syndromes (81), encephalopathy (68), encephalitis (19), and Guillain-Barré syndrome (13). The neuro-COVID incidence curve mirrored the one of general COVID-19 . NS occurred regardless of infection severity, with an average time of 14 days from COVID-19 to neurological symptoms. This finding suggests an immune-mediated mechanism. Neuro-COVID patients had 9 times higher mortality risk and 38 times higher hospitalization risk compared to respiratory syndrome patients. Vascular syndrome patients were 3 times more likely to need ICU care and 6 times more likely to die than those with pre-pandemic vascular syndromes.
Conclusions:

Our study supports the link between neurological syndromes and COVID-19. Incidence correlated with SARS-CoV-2 infection waves, and neuro-COVID patients had worse outcomes than other COVID-19 patients. Vascular syndromes were the most common and were more severe than those seen before the pandemic.

10.1212/WNL.0000000000211918
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