Encephalopathy and encephalitis during acute SARS-CoV-2 infection. Spanish Society of Neurology's COVID-19 Registry

Abstract

Objectives Since the beginning of the COVID-19 pandemic, the Spanish Society of Neurology has run a registry of patients with neurological involvement for the purpose of informing clinical neurologists. Encephalopathy and encephalitis were among the most frequently reported complications. In this study, we analyse the characteristics of these complications. Patients and methods We conducted a retrospective, descriptive, observational, multicentre study of patients with symptoms compatible with encephalitis or encephalopathy, entered in the Spanish Society of Neurology's COVID-19 Registry from 17 March to 6 June 2020. Results A total of 232 patients with neurological symptoms were registered, including 51 cases of encephalopathy or encephalitis (21.9%). None of these patients were healthcare professionals. The most frequent syndromes were mild or moderate confusion (33%) and severe encephalopathy or coma (9.8%). The mean time between onset of infection and onset of neurological symptoms was 8.02 days. Lumbar puncture was performed in 60.8% of patients, with positive PCR results for SARS-CoV-2 in only one case. Brain MRI studies were performed in 47% of patients, with alterations detected in 7.8% of these. EEG studies were performed in 41.3% of cases, detecting alterations in 61.9%. Conclusions Encephalopathy and encephalitis are among the complications most frequently reported in the registry. More than one-third of patients presented mild or moderate confusional syndrome. The mean time from onset of infection to onset of neurological symptoms was 8 days (up to 24 hours earlier in women than in men). EEG was the most sensitive test in these patients, with very few cases presenting alterations in neuroimaging studies. All patients treated with boluses of corticosteroids or immunoglobulins progressed favourably.

Neurologic complications of coronavirus and other respiratory viral infections

“…There were no differences in term of brain MRI abnormalities between severe and mild COVID-19 encephalopathies. However, other reports of neuroimaging abnormalities in COVID-19 associated encephalopathy described cortical or subcortical white matter T2/FLAIR signal hyperintensity as common feature, although in many patients, neuroimaging abnormalities may not be present ( Jain et al, 2020 ; Mahammedi et al, 2020 ; Radmanesh et al, 2020a , Radmanesh et al, 2020b ; Abenza Abildúa et al, 2021 ). Periventricular white matter T2/FLAIR hyperintensity and microbleeds on brain MRI are often attributed to microangiopathy; however, critically ill patients often have severe coagulopathy and severe microangiopathy with several microbleeds ( Maas, 2020 ; Radmanesh et al, 2020b ).…”

Delayed encephalopathy after COVID-19: A case series of six patients

“…[ 11 ] These studies indicate a proportion of patients are at risk of developing encephalopathy up to 4 weeks after the onset of COVID-19; however, it is not clarified in these reports whether COVID-19 pneumonitis had fully improved at the time when neurologic deficits were observed. [ 2 , 3 , 10 , 11 ] In the present series, acute encephalopathy symptoms developed after recovery from COVID-19 without exacerbation of pneumonitis. In addition, the severity of COVID-19 was moderate or severe although no patients required mechanical ventilation, which differs from the previous report.…”

“…[ 1 , 2 , 5 ] According to multicenter study from Spain and Italy, encephalitis, encephalopathy, or acute disseminated encephalomyelitis occurring after four weeks from the onset of COVID-19 was 4 to 8%. [ 2 , 3 ] Ishiyama et al reported that 10 of 12 patients who required ventilation due to COVID-19 developed encephalopathy 38 to 54 days (median, 51 days) after the onset of COVID-19. [ 10 ] In those patients, brain dysfunction, memory disturbance, impaired verbal fluency, and dyscalculia were commonly observed, with tremor seen in 58% of patients.…”

“…[ 1 ] Thus, most cases (90–92%) of acute encephalopathy develop within 3 weeks of COVID-19 onset. [ 2 , 3 ] On the other hand, there have been reports of patients developing symptoms of acute encephalopathy, including impaired consciousness, memory dysfunction, and impaired verbal fluency, more than 4 weeks after the onset of COVID-19 [ 10 , 11 ] ; however, it was not clarified whether the pneumonitis had fully improved at the time of occurring encephalopathy in these reports. [ 10 , 11 ] Furthermore, a disease known as long COVID-19 has been reported, which manifests as systemic symptoms weeks to months after COVID-19.…”

COVID−19, Anti-NMDA Receptor Encephalitis and MicroRNA

“…A retrospective study investigated 841 patients hospitalized with COVID-19 and found that 57% of patients had neurological symptoms ( 69 ). The Spanish Society of Neurology ran a national registry of neurological complications in patients with COVID-19 infection; on the basis of this dataset, a retrospective study investigated patients with encephalopathy or encephalitis ( 70 ). A total of 232 patients were recorded in this dataset, including 51 cases of encephalitis or encephalopathy.…”