Unknown overall incidence but likely common. In one early study of 214 patients in a Wuhan hospital, 37% had impaired consciousness/coma, and 5.7% had an acute stroke. Neurologic involvement was more common in those with severe disease . Older patients with comorbid cardiovascular risk factors were more likely to develop new-onset cerebrovascular disease while infected with SARS-CoV-2 than their younger, healthier peers . Headaches appear to be most common. Other reported neurologic manifestations include Guillain-Barre syndrome [3,4] and encephalitis/meningitis [5-8].
Possible mechanisms include:
Direct CNS involvement by the virus, possibly via hematogenous or lymphatic dissemination or through invasion of peripheral nerve terminals with subsequent trans-synaptic transfer 
Secondary toxic/metabolic encephalopathy as a consequence of metabolic derangements or medications
Seizures are observed with other types of coronavirus infections 
Subclinical seizures occur in 10% of critically ill patients and are only identified through electroencephalography 
Many infections increase risk of stroke, potentially through accelerated atherosclerosis, thrombosis, and systemic inflammation (as evidenced by elevated inflammatory markers, CRP, D-dimer) [2,12]
First step of evaluation depends on acuity - activate the acute stroke team for sudden onset neurologic deficit; otherwise consult inpatient/ICU neurology.
Workup varies depending upon clinical concern (headache, encephalopathy, seizure, stroke). Key principles include thoughtful balance of risk-benefit regarding frequency of neurologic assessments and specific testing such as imaging and EEG. Use of teleneurology via iPad is advised.
Consult neurology for patients with depressed level of consciousness or focal deficit. Management decisions are detailed in the Neurology COVID-19 Protocols.
Common comorbidities in COVID-19 patients influence choice of medications (for example, headache and seizure management if liver injury is present).
Mao L, Wang M, Chen S, et al. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study. medRxiv 2020
Li Y, Wang M, Zhou Y, et al. Acute cerebrovascular disease following COVID-19: A single, retrospective, observational study. The Lancet 2020.
Gutiérrez-Ortiz C, Méndez A, Rodrigo-Rey S, et al. Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology. 2020:10.1212
Toscano G, Palmerini F, Ravaglia S, et al. Guillain–Barré Syndrome Associated with SARS-CoV-2. New England Journal of Medicine. 2020. Li Y-C, Bai W-Z, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients. J. Med. Virol. 2020.
Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. International Journal of Infectious Diseases. 2020;94:55–58.
Duong L, Xu P, Liu A. Meningoencephalitis without Respiratory Failure in a Young Female Patient with COVID-19 Infection in Downtown Los Angeles, Early April 2020. Brain, Behavior, and Immunity. Epub 2020 Apr.:S0889159120305092.
Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features. Radiology. Epub 2020 Mar 31.:201187.
Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain, Behavior, and Immunity. Epub 2020 Apr.Yuanyuan Li , Haipeng Li, Ruyan Fan, Bo Wen, Jian Zhang, Xiaoying Cao, Chengwu Wang, Zhanyi Song, Shuochi Li, Xiaojie Li, Xinjun Lv, Xiaowang Qu, Renbin Huang, Wenpei Liu. Coronavirus Infections in the Central Nervous System and Respiratory Tract Show Distinct Features in Hospitalized Children. Intervirology 2016, 59 (3), 163-169.
Li Y-C, Bai W-Z, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients. J. Med. Virol. 2020.
Yuanyuan Li , Haipeng Li, Ruyan Fan, Bo Wen, Jian Zhang, Xiaoying Cao, Chengwu Wang, Zhanyi Song, Shuochi Li, Xiaojie Li, Xinjun Lv, Xiaowang Qu, Renbin Huang, Wenpei Liu. Coronavirus Infections in the Central Nervous System and Respiratory Tract Show Distinct Features in Hospitalized Children. Intervirology 2016, 59 (3), 163-169.
Oddo M, Carrera E, Claassen J, et al. Continuous electroencephalography in the medical intensive care unit. Crit. Care Med. 2009
Manousakis G, Jensen MB, Cacon MR, et al. The interface between stroke and infectious disease: infectious diseases leading to stroke and infections complicating stroke. Current Neurology and Neuroscience Reports 2009