Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up

Abstract

Objective To systematically describe central (CNS) and peripheral (PNS) nervous system complications in hospitalized COVID-19 patients. Methods We conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission and discharge. Three-month follow-up data were collected using electronic health records. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related. Results From April to September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom required intensive care (ICU) management for respiratory failure. Forty-one CNS/PNS complications were identified in 28 of 61 (45.9%) patients and were more frequent in ICU compared to non-ICU patients. The most common CNS complication was encephalopathy (n = 19, 31.1%), which was severe in 13 patients (GCS ≤ 12), including 8 with akinetic mutism. Length of ICU admission was independently associated with encephalopathy (OR = 1.22). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR = 1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were para/post-infectious, 34 were secondary to critical illness or other causes, and 4 remained unresolved. Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated. Conclusion CNS and PNS complications were common in hospitalized COVID-19 patients, particularly in the ICU, and often attributable to critical illness. When COVID-19 was the primary cause for neurological disease, no signs of viral neurotropism were detected, but laboratory changes suggested autoimmune-mediated mechanisms.

Development and validation of the long covid symptom and impact tools, a set of patient-reported instruments constructed from patients’ lived experience

“…Persisting signs and symptoms three weeks after the acute covid-19 infection may be associated with several distinct clinical entities: 1) organ injury from the acute disease or its treatment (e.g., lung scarring, complications of intensive care, etc. ), 8 10-12 2) post-viral fatigue syndrome, 13-15 3) prolonged viral shedding, especially in immunosuppressed patients, 16 4) reinfection, and 5) mental factors, such as post-traumatic stress. From the patient’s perspective, all or several of these causes are often intertwined and produce a substantial burden of disease.…”

COVID-19 and fatigue: Where do we go from here? Response to Ortelli et al.

“…Information relating to the acute phase of illness would therefore help contextualise longer-term studies of this kind, including the generalisability of findings to the wider population. Furthermore, COVID-19 cases without such severe neurological complications but with ongoing fatigue, both in those hospitalised with severe initial COVID-19 and without, would be important groups to study with the same methodologies.It is possible that the fatigue comprehensively demonstrated in this study could at least in part be attributed to protracted hospitalisation [5]. Taboada et al [8] identified length of hospitalisation as a predictor of greater impairment in functional fatigue status; highlighting further the relevance of reporting functional outcomes in fatigue research.…”

“…It is possible that the fatigue comprehensively demonstrated in this study could at least in part be attributed to protracted hospitalisation [5]. Taboada et al [8] identified length of hospitalisation as a predictor of greater impairment in functional fatigue status; highlighting further the relevance of reporting functional outcomes in fatigue research.…”

“…Fatigue aside, prolonged hospitalisation may be linked to other neuropsychiatric complications following acute COVD-19 infection. For example, length of ICU stay has been significantly correlated with severe encephalopathy [5].Considering this, and whilst a control group of healthy individuals allows for rigorous comparisons to be made, it may be appropriate in future for controls, as suggested by the authors, to instead reflect the effects of prolonged hospitalisation on fatigue and other outcomes. We…”

SARS-CoV-2 Infection and Guillain-Barré Syndrome: A Review on Potential Pathogenic Mechanisms

“…The prevalence of neuro-COVID has been reported to vary between studies. Although the prevalence rate of neurological symptoms is estimated to be around 3.5 to 84% among COVID-19 patients, in most cases the SARS-CoV-2 RNA was not detected in the cerebrospinal fluid (CSF) (28,30,31). Among 58 patients with COVID-19 and neurological symptoms, the SARS-CoV-2 RNA was detected in CSF of 2 patients (3.4%).…”