In this study recently published in Brain, the authors collected detailed clinical and paraclinical data from patients with suspected COVID-19-related neurological disorders in whom the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organisation 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; (ii) inflammatory CNS syndromes (n= 12) including encephalitis (including 2 cases considered para- or post-infectious, 9 cases of acute disseminated encephalomyelitis, with haemorrhage in five, necrosis in one, and myelitis in two, and a single case of isolated myelitis; (iii) ischaemic strokes (n= 8) associated with a pro- thrombotic state (four with pulmonary thromboembolism); (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 any of these categories. The authors underline that early recognition, investigation and management of COVID-19-related neurological disease is challenging. Moreover, further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms, to help guide treatment.