By the time COVID-19 reached New York City in early 2020, preliminary reports from Asia and Europe had put specialists at NYU Langone on heightened alert for neurological dysfunction among patients with the virus. Subsequent data collected over time has informed a new study showing that one in seven individuals infected with COVID-19 experiences potentially damaging neurological injuries, informing ever-evolving treatment protocols for the virus.

The National Institutes of Health (NIH)–funded study, led by researchers at NYU Grossman School of Medicine, closely followed 606 adult patients diagnosed with COVID-19 who experienced brain complications or other nerve-related medical conditions across NYU Langone between March 10 and May 20. While no direct invasion or inflammation of the brain or nerves was found, the neurological injuries observed in these patients—from temporary confusion to stroke and seizures—were associated with prolonged low body oxygen levels, electrolyte imbalances, and severe infection or kidney failure. Further, patients with neurological complications were found to have a 38 percent higher risk of dying in hospital; surviving patients had a 28 percent higher risk of requiring long-term or rehabilitation therapy immediately upon discharge.

“The neurological complications seen in COVID-19 are predominantly the secondary effects of being severely ill and suffering from low oxygen levels in the body for prolonged periods,” says study lead investigator Jennifer A. Frontera, MD, professor in the Department of Neurology.

Published in October 2020 in Neurology, the study also showed that neurological symptoms usually arose within 48 hours of the onset of COVID-19 symptoms. Half of those neurologically affected were over the age of 71, significantly older than the median age of 63 among the other 3,885 patients treated for COVID-19 across NYU Langone hospitals at the time of the study.

“Our results suggest that physicians need to be more aggressive in stabilizing body oxygen levels in patients with COVID-19 as a potentially key therapy for stopping, preventing, and/or possibly reversing neurological problems,” says study senior investigator Steven L. Galetta, MD. Approaches to stave off neurological complications by raising blood oxygen levels, including early intubation or use of heart–lung machines (ECMO), continue to inform the investigation of COVID-19 treatment protocols at NYU Langone.