People hospitalized with COVID-19 and neurological problems including stroke and confusion have a higher risk of dying than other COVID-19 patients, according to a study published online today by researchers at Montefiore Health System and Albert Einstein College of Medicine in the journal Neurology®, the medical journal of the American Academy of Neurology. These findings have the potential to identify and focus treatment efforts on individuals most at risk and could decrease COVID-19 deaths.

The study looked at data from 4,711 COVID-19 patients who were admitted to Montefiore during the six-week period between March 1, 2020, and April 16, 2020. Of those patients, 581 (12%) had neurological problems serious enough to warrant brain imaging. These individuals were compared with 1,743 non-neurological COVID-19 patients of similar age and disease severity who were admitted during the same period.

"This study is the first to show that the presence of neurological symptoms, particularly stroke and confused or altered thinking, may indicate a more serious course of illness, even when pulmonary problems aren't severe," said David Altschul, M.D., chief of the division of neurovascular surgery at Einstein and Montefiore and associate professor in the Leo M. Davidoff Department of Neurological Surgery and of radiology at Einstein. "Hospitals can use this knowledge to prioritize treatment and, hopefully, save more lives during this pandemic."

Among people who underwent brain imaging, 55 were diagnosed with stroke and 258 people exhibited confusion or altered thinking ability. Individuals with stroke were twice as likely to die (49% mortality) compared with their matched controls (24% mortality)—a statistically significant difference. People with confusion had a 40% mortality rate compared with 33% for their matched controls—also statistically significant.

More than half the stroke patients in the study did not have hypertension or other underlying risk factors for stroke. "This highly unusual finding agrees with other studies of people with COVID-19 in suggesting that infection with the novel coronavirus is itself a risk factor for stroke," said Dr. Altschul, who is also surgical director of the Montefiore Comprehensive Center for Stroke Care, and the study co-author, along with Emad Eskandar, M.D., M.B.A., chair of neurological surgery at Einstein and Montefiore, a professor in the Leo M. Davidoff Department of Neurological Surgery, the department of psychiatry and behavioral sciences, in the Dominick P. Purpura Department of Neuroscience at Einstein. Dr. Eskandar also holds the Jeffrey P. Bergstein Chair and the David B. Keidan Chair in Neurological Surgery.

The paper is titled, "Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19." The senior author was Mark Mehler, M.D., professor and chair of the Saul R. Korey Department of Neurology at Einstein and Montefiore, professor of neuroscience and of psychiatry and behavioral sciences, director of the Institute for Brain Disorders and Neural Regeneration, and the Alpern Family Foundation Chair in Cerebral Palsy Research.

Charles Esenwa, M.D., assistant professor of neurology, and Daniel Labovitz, M.D., associate professor of neurology and of medicine, played a major role in selecting participants for the study.

Additional Einstein-Montefiore authors are: Rafael de La Garza Ramos, M.D., Phillip Cezayirli, M.D., Santiago R Unda, M.D., Joshua Benton, B.A., Joseph Dardick, B.A., Aureliana Toma, M.D., Nikunj Patel, B.A., Avinash Malaviya, B.A., M.S., David Flomenbaum, B.S., Jenelys Fernandez-Torres, B.A., Jenny Lu, B.A., Ryan Holland, M.D., Elisabetta Burchi, M.D., Richard Zampolin, M.D., Kevin Hsu, M.D., Andrew McClelland, M.D., Judah Burns, M.D., Amichai Erdfarb, M.D., Rishi Malhotra, M.D., Michelle Gong, M.D., Peter Semczuk, D.D.S., M.P.H., Victor Ferastraoaru, M.D., Jillian Rosengard, M.D., Daniel Antoniello, M.D., Mark Milstein, M.D., and Alexis Boro, M.D

About Albert Einstein College of Medicine
Albert Einstein College of Medicine is one of the nation's premier centers for research, medical education, and clinical investigation. During the 2020-21 academic year, Einstein is home to 721 M.D. students, 178 Ph.D. students, 109 students in the combined M.D./Ph.D. the program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,900 full-time faculty members located on the main campus and at its clinical affiliates. In 2020, Einstein received more than $197 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS.

Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital, and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn, and on Long Island. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.

About Montefiore Health System
Montefiore Health System is one of New York's premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester, and the Hudson Valley. It is comprised of 11 hospitals, including the Children's Hospital at Montefiore, Burke Rehabilitation Hospital, and close to 200 outpatient care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology, and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families.