Clinical description of the broad range of neurological presentations of COVID-19: A retrospective case series

Abstract

Background: Neurological disorders associated with SARS-CoV-2 infection represent a clinical challenge because they encompass a broad neurological spectrum and may occur before the diagnosis of COVID-19. Methods: In this monocentric retrospective case series, medical records from patients with acute neurological disorders associated with SARS-CoV-2 infection from medicine departments of an academic center in Paris area were collected between March 15th and May 15th 2020. Diagnosis of SARS-CoV-2 was ascertained through specific RT-PCR in nasopharyngeal swabs or based on circulating serum IgG antibodies. Results: Twenty-six patients diagnosed with SARS-CoV-2 infection presented with neurological disorders: encephalitis (N=8), encephalopathy (N=6), cerebrovascular events (ischemic strokes N=4 and vein thromboses N=2), other central nervous system (CNS) disorders (N=4), and Guillain-Barré syndrome (N=2). The diagnosis of SARS-CoV-2 was delayed on average 1.6 days after the onset of neurological disorder, especially in case of encephalitis 3.9 days, encephalopathy 1.0 day, and cerebrovascular event 2.7 days. Conclusions: Our study confirms that COVID-19 can yield a broad spectrum of neurological disorders. Because neurological presentations of COVID-19 often occur a few days before the diagnosis of SARS-COV-2 infection, clinicians should take preventive measures such as patient isolation and masks for any new admission to avoid nosocomial infections. Anti-SARS-CoV2 antibody detection in RT-PCR SARS CoV-2 negative suspected cases is useful to confirm a posteriori the diagnosis of atypical COVID-19 presentations.

Comparison of Disease Profiles and Three-Month Outcomes of Patients with Neurological Disorders with and without COVID-19

“…This is consistent with other studies. [ 4 12 ] In this study, although cerebral venous sinus thrombosis (CVT) formed just 2.1% of the cohort, there were more patients with CVT who were COVID-19 positive, and this association is not new. [ 13 ] There were significantly more patients with meningitis who were COVID-19 positive.…”

Severe Neurological Manifestations of Covid-19: Case Series

“…Meppiel et al stated that neurological manifestations occurred after the first symptom of COVID-19, with a mean delay of 7 days for encephalitis, 12 days for acute ischemic cerebrovascular syndrome, and 18 days for GBS 14 . On the other hand, there are studies reporting that various neurological manifestations can occur in patients infected with SARS-CoV-2 without clinical manifestations of respiratory dysfunction 32 . In a review, it was concluded that patients with COVID-19 may develop neurological manifestations before, during, and even after the onset of common symptoms of COVID-19 4 .…”

“…Another important factor is the delay between the onset of neurological complications and the confirmation of SARS-CoV-2 infection, which was addressed in a study and found that confirmation of SARS-CoV-2 infection was delayed, on average, by 1.6 days from the onset of neurological manifestations, whereas in the case of encephalitis the delay was 3.9 days and 2.7 days for cerebrovascular events 32 . In the case of patient 3, diagnosed with encephalitis, the infection was confirmed only 7 days after the onset of symptoms.…”

COVID-19-associated encephalitis.

“…Encephalitis is marked by elevated levels of proinflammatory cytokines, chemokines, interleukin-6, interleukin-1, interleukin-18, TNF-α, CXCL10, with serological abnormalities of c-reactive protein, procalcitonin, D-dimer, and ferritin being particularly associated with increased risk of severity and mortality (13)(14)(15)(16)(17).…”

“…Additionally, COVID-19-associated encephalitis can produce hyperintensities in the mesial temporal lobe, subcortical white matter, brainstem, and claustrum (14).…”