Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Abstract

Background Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain. Methods During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.

Neurological manifestations of coronavirus infections – a systematic review

“…Cerebrovascular diseases were among the most commonly reported complications, including ischemic stroke, and cerebral hemorrhages. 41,[54][55][56][57][58][59] . Studies from China, Spain and the US report that 1-1.6% of hospitalized patients were affected by cerebrovascular disease.…”

Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team

“…8 COVID-19 infection, its complications and its treatment can have direct effects on the brain leading to neuropsychiatric disorders including seizures, delirium, demyelination, encephalopathies and stroke. 5,9 Current studies on psychiatric presentations of SARS-CoV-2 have several limitations. In terms of geography, most are from Wuhan, China.…”

Human Pluripotent Stem Cell-Derived Neural Cells and Brain Organoids Reveal SARS-CoV-2 Neurotropism

“…While the disease primarily affects the respiratory system, damage and dysfunction has also been found in other organs, including the kidney, heart, liver, and brain (Yang et al, 2020b). Neurological complications, such as cerebrovascular injury, altered mental status, encephalitis, encephalopathy, dizziness, headache, hypogeusia, and hyposmia, as well as neuropsychiatric ailments, including new onset psychosis, neurocognitive syndrome, and affective disorders, have been reported in a significant number of patients (Mao et al, 2020;Varatharaj et al, 2020). Viral RNA has been detected in the brain and cerebrospinal fluid (CSF) of some patients with COVID-19 and concomitant neurological symptoms (Helms et al, 2020;Moriguchi et al, 2020;Puelles et al, 2020;Solomon et al, 2020).…”