Consecutive patients diagnosed with SARS-CoV2 admitted to 5 hospitals in Detroit Medical Center from March 3rd, 2020-May 1st, 2020 were included. Basic demographics and clinical manifestations were included. Relevant laboratory findings and neuroimaging were reported.

413 patients were included in the study. Patients’ demographics were as follows: mean age-66 years, 212 (51%) male, 346 (87%) African-American. 219(53%) patients had neurological symptoms at presentation, 32 patients presented purely with neurological symptoms. Other symptoms at onset include-respiratory 312(76%), constitutional 250(61%) and gastrointestinal 104(25%). 121(29%) patients were admitted to ICU, mean days from admission to ICU was 3.14days.

Incidence of neurological presentations were as follows: Encephalopathy 191(46.25%), myalgia 51(12.35%), headache 27 (6.54%), vertigo 20 (4.84%), hypogeusia 14 (3.39%), anosmia 12 (2.9%), stroke 13(3.14%), seizure 11 (2.9%).

For patients with encephalopathy, median GCS at the onset of encephalopathy was 13 with IQR4. 94 (49.21%) of these patients were admitted to ICU; 53(27.75%) were without coexisting toxic, metabolic or hypoxic factors contributing to encephalopathy.

For patients with stroke, 12 patients presented with acute ischemic stroke, 2 with hemorrhagic conversion and 1 patient had cerebral venous sinus thrombosis. Characteristics of stroke were as follows: 8 -multiple vascular territory, 11-cryptogenic etiology, 3- concurrent thromboembolic event. Median D-dimer was 5.76mg/LFEU(IQR3.74) and fibrinogen 550mg/dl(IQR 2.1). 2 patients received thrombolysis and 1 underwent thrombectomy. Mortality was 77%, Modified Rankin Scale (MRS)at baseline was 0-2 and all except 1 patient had MRS of 4-6 on discharge.

Neurological manifestation is common amongst patients with SARS-CoV-2.Presence of encephalopathy or stroke confers an increased risk of mortality and morbidity.