Abstract
There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may damage the central nervous system (CNS).[1,2] Brain magnetic resonance imaging (MRI) results or cerebrospinal fluid findings may be suggestive of encephalitis or may be normal for patients with CNS symptoms.[3,4] Electroencephalography (EEG) is a tool to identify neurologic injury and understand underlying mechanisms
Biological, MRI, and EEG Findings for Patients With COVID-19. The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19– related encephalopathy and guide treatment strategy
SI conversion factors: To convert sodium to millimoles per liter, multiply by 1.0; and calcium to millimoles per liter, multiply by 0.25. a COVID-19 severity was evaluated according to the World Health Organization nadir scale11: 1, nonhospitalized patients without activity limitation; 2, nonhospitalized patients with activity limitation; 3, hospitalized patients without oxygen requirement; 4, hospitalized patients with oxygen requirement; 5, hospitalized patients with noninvasive ventilation; 6, hospitalized patients with invasive ventilation; and 7, deceased patient at discharge. b We evaluated all drugs taken by patient the day of the EEG. c One patient had both interictal epileptic activities and seizures. d Patients were assessed as having biological abnormalities if they presented with one of the following abnormalities: hyponatremia, hypernatremia, hypocalcemia, renal insufficiency, hepatic dysfunction, hypercapnia, or hyperosmolarity
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may damage the central nervous system (CNS).[1,2] Brain magnetic resonance imaging (MRI) results or cerebrospinal fluid findings may be suggestive of encephalitis or may be normal for patients with CNS symptoms.[3,4] Electroencephalography (EEG) is a tool to identify neurologic injury and understand underlying mechanisms. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, periodic EEG discharges with triphasic morphologic characteristics were reported in 1 patient with alteration of consciousness,[5] with unremarkable results of cerebrospinal fluid analysis and brain MRI. Frontal periodic EEG discharges were further reported in 5 critically ill patients with COVID-19.6 To our knowledge, few studies have evaluated EEG findings together with clinical, biological, and MRI findings in patients with COVID-19, and these studies did not show evidence of specific patterns.[7,8,9]. We had 3 main goals: (1) to provide a description of the clinical symptoms and the biological, EEG, and MRI patterns observed in these patients, including their frequency and their prognostic value; (2) to analyze EEG patterns in light of MRI, clinical, and biological findings; and (3) to further define CORE
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
