Neurological symptoms are frighteningly common among hospitalized covid-19 patients, and the symptoms are associated with a greater risk of death, a new study shows.

A paper published Tuesday in the medical journal JAMA Network Open outlines a project studying patients from around the globe. Scientists, including several at the University of Pittsburgh, analyzed data surrounding the incidence, severity and health outcomes of covid patients who experienced a litany of neurological symptoms.

“We wanted to ask this question: how many people with covid had neurological symptoms and syndromes?” said Dr. Sherry Chou, principal investigator for the study and associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh. “And we want to know the impact: does having neurological symptoms on top of covid impact your outcome?”

The data was gathered through collaboration with the Global Consortium Study of Neurologic Dysfunction in Covid-19 (GCS-NeuroCOVID), a network of neuro-intensivists studying patients around the world, and the European Academy of Neurology Neuro-Covid Registry (ENERGY).

The consortium studied 133 sites and 3,744 hospitalized covid patients across all continents except Antarctica. Chou said they tracked both neurological symptoms that self-reported — the patient described the symptoms — and those that were clinically verified, in which physicians could detect abnormalities even if the patient was unable to.

Among all of the patients, 82% of the patients had neurological symptoms, and more than 50% of them had clinically verified symptoms. Nearly four out of 10 reported headaches, and about three out of 10 said they lost their sense of smell or taste.

Acute encephalopathy, which consists of symptoms like delirium, agitation and confusion, was the most common symptom recorded, affecting nearly half of the patients. Coma and strokes were the second and third most common, affecting 17% and 6% of patients, respectively.

“This is concerning and important to know that more than half of the patients who are sick enough to require hospitalization with covid-19 can have some sort of neurological syndrome,” Chou said. “This gives us a sense of the magnitude of this problem and it tells us that we need to pay more attention to the neurological problems patients may face, and more importantly, how does this affect people long-term in the survivors.”

Though scientists worried early on that covid-19 would directly attack the brain and nervous system, causing meningitis or encephalitis, the consortium found this occurred in less than 1% of the patients studied.

Chou said there is likely a “second chapter to the story,” especially given the harsh findings for those who experienced the symptoms. The scientists found that those who suffer neurological symptoms with covid were six times more likely to die, compared to those without.

She predicted additional studies exploring the data even more closely, including closer looks at the effects of specific neurological symptoms and the long-term impacts of these symptoms on survivors after they recover from the virus.

The implications of this study are significant, Chou said. Throughout the pandemic, there have been emerging reports of covid patients and long-haulers experiencing various neurological and psychological symptoms — everything from loss of smell to brain fog. Chou said one of the goals of the study was to identify the scope of the problem so physicians can distribute resources accordingly.

“We know from all the emerging reports that neurological problems can happen, but we need to get a sense of how big a problem this is, how often it happens,” she said. “So that at different places and different ground conditions, people can look at the resources they have and say… ‘This is how I’m going to reorganize my resources so that I can better address this.’ ”

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