Neurologic manifestations associated with COVID-19: a multicentre registry

Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians

“…A diagnosis of encephalopathy or encephalitis was reported in only 0.1 to 3% of patients in these cohort studies. However, among all the neurological manifestations, the proportion of encephalopathy and encephalitis was 14% in the case reports patients (14/98, Table 2 ), 13% in the UK-wide surveillance study (16/152) [7] , and respectively 13% (8/64), 49% (21/43) and 40% (88/222) in the cohort of Kremer et al [9] , Paterson et al [8] and Meppiel et al [10] .…”

“…The most common manifestations were myalgia (1.8 to 32.4%), headache (1.8 to 20.4%), and impaired consciousness (1.8 to 21.3%). Four other cohort studies focused only on COVID-19 patients with neurological manifestations and described 482 patients [7] , [8] , [9] , [10] ( Table 1 ). In addition, we identified 57 articles reporting 98 COVID-19 patients with characterized neurological diseases ( Table 2 ).…”

“…Encephalopathy and encephalitis encompass a wide range of clinical and radiological entities, as shown by the 14 patients reported in case reports or series ( Table 3 ) and the 142 patients described in five of the cohort studies ( Table 1 ) [4] , [5] , [8] , [9] , [10] . Neurological manifestations occurred from 0 to 34 days after the first signs of COVID-19 and included altered consciousness with confusion, delirium or comatose state, neuropsychiatric changes, seizure, focal neurological sign, and abnormal movements.…”

“…Intrathecal oligoclonal bands synthesis was present in five patients out of 20 tested (25%), and SARS-CoV-2 PCR was positive in four out of 92 tested (4%). Brain imaging was performed in all patients including magnetic resonance imaging (MRI) in 127 patients (81%) and allowed to categorize patients in different categories: 1/non-specific COVID-19-related encephalopathy ( n = 86) [4] , [5] , [8] , [10] : delirium and/or neuropsychiatric changes and/or seizures, without pleiocytosis or brain imaging abnormalities consistent with inflammation, but microvascular acute lesions in nine patients [4] , [10] ; 2/acute demyelinating encephalomyelitis (ADEM, n = 13) [8] , [9] , [12] , [13] , [14] including one patient with the acute hemorrhagic leukoencephalopathy form [8] and two patients with restricted diffusion lesions raising the question of CNS small vessel vasculitis as differential diagnosis [12] , [13] ; 3/acute necrotizing encephalopathy (ANE, n = 4) [9] , [15] , [16] ; 4/limbic encephalitis ( n = 9) [5] , [8] , [9] , [10] , [17] , [18] ; 5/Bickerstaff's brainstem encephalitis ( n = 5) [5] , [8] , [10] , [19] ; 6/encephalopathy with focal or diffuse leptomeningeal abnormalities ( n = 13) [9] , [10] ; 7/miscellaneous encephalopathy and encephalitis with other clinical or radiological findings: encephalitis with pleiocytosis and normal brain MRI ( n = 9) [10] , [20] , [21] , encephalitis with akathisia and chorea ( n = 1) [5] , cytotoxic lesion of the corpus callosum ( n = 3) [9] , [10] , [22] , focal or multifocal cortical FLAIR hyperintensities ( n = 2) [4] , [23] , white matter and/or basal ganglia lesions without mention of ADEM or ANE ( n = 11) [9] , ...…”

“…Neurological short-term prognosis was available for 26 patients in the case reports ( Table 3 ) or case series [29] , [32] , [33] and 116 patients in cohort studies [4] , [5] , [8] , [9] , [10] . A complete or partial recovery was noted in 109/142 patients (77%) either spontaneously ( n = 68) or with immunotherapy ( n = 41) including high-dose steroid treatment and/or intravenous immunoglobulins (IV Ig).…”