To evaluate various neurological manifestations in patients with Leptospirosis presenting to a tertiary care hospital in North India.

Leptospirosis is the most common zoonotic disease in the world. The Centre for Disease Control estimates around 1 million cases annually across the globe with more than 60000 deaths. Neurological manifestations in Leptospirosis are largely underreported and usually mimic those of other common neuro-infections like tubercular meningitis. Early identification is key to rapidly improving patient outcomes.

This Retrospective observational study, conducted between 2021 and 2023, involved the analysis of medical records of patients diagnosed with Neuro-leptospirosis at a tertiary care hospital in North India. From the medical records, data on clinical presentations, CSF analyses, and MRI findings were collected.

Our study evaluated the various neurological manifestations of 33 patients diagnosed with Neuro-leptospirosis. The following results were obtained:
• Fever was uniformly present in all 33 patients (100%) consistent with the typical presentation of leptospirosis.
• Headache in 13 patients (39.4%), vomiting in 10 patients (30.3%) and seizures in 10 patients (30.3%) were the most common neurological manifestations seen.
• Neck stiffness, a classical sign of meningitis was observed in 12 patients (36.4%).
• Neuromuscular involvement was seen as weakness in 5 patients (15.2%). 
• CSF findings: Cell count (85 ± 223.8 cells/ mm3), protein (89 ± 63.89 mg/dL) and glucose (74.2 ± 30.22 mg/dL) were suggestive of meningeal irritation and inflammation.
• MRI findings: Were seen in 17 patients (51.5%) which includes meningitis in 7 patients (21.2%), infarction in 1 patient (3%) and hydrocephalus in 1 patient (3%) highlighting the diverse neurological complications in leptospirosis.

Knowledge about the neurological manifestations of leptospirosis among other differential neuro-infections is pertinent. These features can potentially aid in accurate and timely diagnosis, improving patient management and outcomes.