Abstract Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria. Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and (v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies. The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms, which will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.

The diagnosis of epilepsy is incorrect in up to 20% of cases so should be revisited if attacks are not responding to treatment. We present a case of long QT syndrome that remained undiagnosed in the epilepsy clinic for 15 years until a near-fatal arrhythmia revealed the diagnosis and allowed effective treatment of her attacks. We hope this near miss raises awareness of long QT syndrome as a potentially fatal, rare but treatable condition that neurologists must consider in people with a label of refractory epilepsy. We provide practical pointers to increase the chance of early diagnosis and explore the impact of a late diagnosis for the patient and her family.

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BackgroundThe National Hospital for Neurology and Neurosurgery admits Parkinson’s disease (PD) patients for medical management and deep brain stimulation, as well as non-PD inpatients on levodopa with dystonia or atypical Parkinsonism. Previous work showed 24.5% of administrations were outside of the recommended 30-minute time window.MethodsWe introduced interventions based on the Leeds Quality Improvement Project “Get it Right on Time”, adapted for local protocols and focused questionnaires. Due to cancellation of elective PD admissions during the SARS-CoV-2 crisis, we included all inpatients on levodopa. We tested differences between pre-intervention and post-intervention groups using Chi-squared (χ2), with post hoc comparisons to examine individual time categories.ResultsWe compared 177 post-intervention administration episodes to 404 in the pre-intervention group. Across all time categories, we found a significant change in administration timings between groups (χ2=35.9, p<0.001). This was driven by an increase in levodopa given on time, from 11.4% to 23.2% (p<0.001) and a decrease in levodopa given up to 15 minutes late, from 31.2% to 17.5% (p<0.001).ConclusionWard-based interventions improve timely levodopa administration. Including non-PD patients altered the study population and may have impacted results. Further work includes surveying staff to identify additional interventions and investigating a PD-only cohort.vivalevee@gmail.com