Post-infectious neurological complications of COVID-19 – A tertiary care center experience

The neurological manifestations of acute SARS-CoV-2 infection are well established, but limited understanding of the post-infectious neurological complications of COVID-19 (PINCC) contributes to significant morbidity and mortality. Hence in this study, we aimed to describe the clinical, radiological, and electrophysiological spectrum and outcome of PINCC from a tertiary referral center. We identified 18 cases with diverse neurological manifestations following recovery from an acute SARS-CoV-2 infection. The neurological manifestations, magnetic resonance imaging findings of the brain and spinal cord, nerve conduction studies, and the treatment and outcome data were collected from electronic medical records. The mean age of presentation was 47± 18.5 years, and 11 patients (61 %) were male. For 11 (61 %) patients, prior COVID-19 symptoms were minimal or absent. The mean time to onset of neurological manifestations was 3 weeks after COVID-19 infection (range 1–8 weeks). 14 patients (77.8 %) had central nervous system (CNS) manifestations, and 4 (22.2 %) had peripheral nervous system (PNS) manifestations. The CNS manifestations included cerebrovascular events in 7, demyelination in 4, and aseptic meningitis, amnestic mild cognitive impairment, and disseminated tuberculosis in one case each. PNS manifestations were Guillain-Barré syndrome, mononeuritis multiplex, asymmetric polyradiculoneuropathy, and isolated diaphragm palsy in one patient each. Post-infectious neurological complications of COVID-19 can involve both central and peripheral nervous system and is independent of the severity of acute infection.