tetano
Editor, Senior Moderator
J Neurol
. 2021 Jan 13;1-19.
doi: 10.1007/s00415-020-10380-x. Online ahead of print.
Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up
Vardan Nersesjan[SUP] 1 [/SUP], Moshgan Amiri[SUP] 1 [/SUP], Anne-Mette Lebech[SUP] 2 3 [/SUP], Casper Roed[SUP] 2 [/SUP], Helene Mens[SUP] 2 [/SUP], Lene Russell[SUP] 4 [/SUP], Lise Fonsmark[SUP] 4 [/SUP], Marianne Berntsen[SUP] 5 [/SUP], Sigurdur Thor Sigurdsson[SUP] 5 [/SUP], Jonathan Carlsen[SUP] 6 [/SUP], Annika Reynberg Langkilde[SUP] 6 [/SUP], Pernille Martens[SUP] 6 [/SUP], Eva L?bner Lund[SUP] 7 [/SUP], Klaus Hansen[SUP] 1 [/SUP], Bo Jespersen[SUP] 8 [/SUP], Marie Norsker Folke[SUP] 9 [/SUP], Per Meden[SUP] 9 [/SUP], Anne-Mette Hejl[SUP] 9 [/SUP], Christian Wamberg[SUP] 10 [/SUP], Michael E Benros[SUP] 11 12 [/SUP], Daniel Kondziella[SUP] 13 14 [/SUP]
Affiliations
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.
Keywords: COVID-19; Coronavirus; Critical illness; Encephalopathy; Myelitis; SARS-COV-2.
. 2021 Jan 13;1-19.
doi: 10.1007/s00415-020-10380-x. Online ahead of print.
Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up
Vardan Nersesjan[SUP] 1 [/SUP], Moshgan Amiri[SUP] 1 [/SUP], Anne-Mette Lebech[SUP] 2 3 [/SUP], Casper Roed[SUP] 2 [/SUP], Helene Mens[SUP] 2 [/SUP], Lene Russell[SUP] 4 [/SUP], Lise Fonsmark[SUP] 4 [/SUP], Marianne Berntsen[SUP] 5 [/SUP], Sigurdur Thor Sigurdsson[SUP] 5 [/SUP], Jonathan Carlsen[SUP] 6 [/SUP], Annika Reynberg Langkilde[SUP] 6 [/SUP], Pernille Martens[SUP] 6 [/SUP], Eva L?bner Lund[SUP] 7 [/SUP], Klaus Hansen[SUP] 1 [/SUP], Bo Jespersen[SUP] 8 [/SUP], Marie Norsker Folke[SUP] 9 [/SUP], Per Meden[SUP] 9 [/SUP], Anne-Mette Hejl[SUP] 9 [/SUP], Christian Wamberg[SUP] 10 [/SUP], Michael E Benros[SUP] 11 12 [/SUP], Daniel Kondziella[SUP] 13 14 [/SUP]
Affiliations
- PMID: 33438076
- PMCID: PMC7803470
- DOI: 10.1007/s00415-020-10380-x
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.
Keywords: COVID-19; Coronavirus; Critical illness; Encephalopathy; Myelitis; SARS-COV-2.