Case series/case reports (Indigo)
The objective of this paper was to provide an overview of the spectrum, characteristics and outcomes of neurological manifestations associated with SARS-CoV-2 infection. The authors conducted a multicentric, retrospective study during the French COVID-19 epidemic in March-April 2020. All COVID-19 patients with de novo neurological manifestations were eligible. 222 COVID-19 patients with neurological manifestations from 46 centres in France were included. Median age was 65 years (IQR 53-72), and 136 patients (61.3%) were male. COVID-19 was severe or critical in 102 patients (45.2%). The most common neurological diseases were COVID-19 associated encephalopathy (67/222, 30.2%), acute ischaemic cerebrovascular syndrome (57/222, 25.7%), encephalitis (21/222, 9.5%), and Guillain-Barré Syndrome (15/222, 6.8%).
Neurological manifestations appeared after first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19 associated encephalopathy, 7 (5-10) days in encephalitis, 12 (7-18) days in acute ischaemic cerebrovascular syndrome and 18 (15-28) days in Guillain-Barré Syndrome. Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Among patients with acute ischaemic cerebrovascular syndrome, 13/57 (22.8%) had multi-territory ischaemic strokes, with large vessel thrombosis in 16/57 (28.1%). Brain MRI of encephalitis patients showed heterogeneous acute non-vascular lesions in 14/21 patients (66.7%). Cerebrospinal fluid was analysed in 97 patients (43.7%), with pleocytosis seen in 18 patients (18.6%) and a positive SARS-CoV-2 PCR in 2 patients with encephalitis. The median (IQR) follow-up was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%). The authors concluded that clinical spectrum and outcomes of neurological manifestations associated with SARS-CoV-2 infection were broad and heterogeneous, suggesting different underlying pathogenic processes.