Clinical, cerebrospinal fluid, and neuroimaging findings in COVID-19 encephalopathy: a case series

Objective To describe the clinical, neurological, neuroimaging, and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center. Methods We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consult...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Neurological sciences 2021-02, Vol.42 (2), p.479-489
Hauptverfasser: Tuma, Raphael L., Guedes, Bruno F., Carra, Rafael, Iepsen, Bruno, Rodrigues, Júlia, Camelo-Filho, Antonio Edvan, Kubota, Gabriel, Ferrari, Maíra, Studart-Neto, Adalberto, Oku, Mariana Hiromi, Terrim, Sara, Lopes, Cesar C. B., Passos Neto, Carlos E. B., Fiorentino, Matheus D., Souza, Julia C. C., Baima, José Pedro S., Silva, Tomás, Perissinotti, Iago, Martin, Maria da Graça M., Gonçalves, Marcia, Fortini, Ida, Smid, Jerusa, Adoni, Tarso, Lucato, Leandro, Nitrini, Ricardo, Gomes, Hélio, Castro, Luiz H.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung:Objective To describe the clinical, neurological, neuroimaging, and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center. Methods We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020. Results Fifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate, and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series, the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2), or severe (3), p < 0.001). Conclusion In our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.
ISSN:1590-1874
1590-3478
1590-3478
DOI:10.1007/s10072-020-04946-w