Hypertension, diabetes ‘common’ in patients with neurological complications of COVID-19
Among patients with COVID-19, those who had hypertension or type 2 diabetes were more likely to develop neurological conditions associated with the infectious disease, data from a small study show.
“We recommend that physicians include a neurological exam as part of their patients’ physical exams and consider the complications described in patients with COVID-19,” Colbey W. Freeman, MD, chief resident in the department of radiology at Penn Medicine in Philadelphia, told Healio Primary Care.
Freeman and colleagues analyzed head images from 81 patients (mean age, 66.3 years; 36 women) within a tertiary health system who tested positive for SARS-CoV-2. The patients’ demographic, comorbidity information, laboratory values and neuroimaging findings from CTs and/or MRIs were also recorded.
According to the researchers, 18 of the patients’ (mean age, 60.5 years; nine women, 12 Black) laboratory values and neuroimaging results showed what researchers deemed “critical” findings: 12 had acute/subacute infarct; four had large vessel intracranial occlusion; three had subarachnoid and intraparenchymal hemorrhage; and one had hypoxic-ischemic encephalopathy.
The most common comorbidities among these 18 patients were hypertension (72.2%) and type 2 diabetes (50%). These 18 patients also had below normal mean hemoglobin values (9.3 g/dL); elevated serum creatinine (1.73 mg/dL), D-dimer (16.3 ug/mL) and fibrinogen (455.9 mg/dL) values; normal mean platelet counts (259.2 microliter-1) and “mildly elevated” mean prothrombin time (14.2 seconds), partial thromboplastin time (46.1 seconds) and international normalized ratio (1.5). The full results will be presented later this month during the virtual Radiological Society of North America annual meeting.
“COVID-19 is associated with neurologic manifestations, and hypertension and type 2 diabetes mellitus are common in individuals who develop these manifestations,” Freeman said in a press release. “These populations may be at higher risk for neurologic complications and should be monitored closely.”
Freeman added in the interview that physicians should highlight the uncommonness of his findings when discussing them with patients.
“While many of the complications described in our work are devastating, they are still rare when the total number of people with COVID-19 is considered,” he said. “Among all patients admitted to our health system during the study, just over 1% met our criteria for critical findings on brain images. [Our results] do not include individuals who were not admitted to the hospital. The overall fraction of patients with COVID-19 and critical brain findings would likely be lower if they had been included.”
He also said the researchers plan to investigate neurologic complications in patients with COVID-19 that require extracorporeal membrane oxygenation and, separately, assess “delayed, long-term and chronic neurologic manifestations that may not be known in this early period in the pandemic.”