Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone.

Patrick J Howlett,Janet T Scott,Colin S Brown,Jonathon M Read,Anna R Walder,Tom Solomon,Foday Sesay,Marta Lado,Malcolm G Semple,Abdul N’Jai,Stephen Sevalie,Reena Dwivedi,Marylou Solbrig,Paul J Steptoe,Nicholas A.V Beare,Foday Sahr,Gibrilla F Deen,Felicity Fitzgerald,Durodami R Lisk

doi:10.3201/eid2408.171367

Abstract

We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae. Survivors meeting neurologic criteria were invited from a cohort of 361 EVD survivors to attend a preliminary clinic. Those whose severe neurologic features were documented in the preliminary clinic were referred for specialist neurologic evaluation, ophthalmologic examination, and psychiatric assessment. Of 35 survivors with neurologic sequelae, 13 had migraine headache, 2 stroke, 2 peripheral sensory neuropathy, and 2 peripheral nerve lesions. Of brain computed tomography scans of 17 patients, 3 showed cerebral and/or cerebellar atrophy and 2 confirmed strokes. Sixteen patients required mental health followup; psychiatric disorders were diagnosed in 5. The 10 patients who experienced greatest disability had co-existing physical and mental health conditions. EVD survivors may have ongoing central and peripheral nervous system disorders, including previously unrecognized migraine headaches and stroke.

Highlights

We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae
In those invited to the preliminary clinic, on multivariable analysis, the presence of minor criteria was associated with nonattendance
Our specialist case series from the 34 Military Hospital (34MH) survivor’s cohort confirms the presence of central and peripheral nervous system disorders and found these to be associated with a broad range of disability

Summary

Introduction

We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae. Central nervous system (CNS) viral invasion by EVD had been suspected but unproven until the West Africa EVD epidemic In this outbreak, individual case-patient reports describe clinical features of meningoencephalitis or meningitis during and after acute Ebola virus (EBOV) infection, accompanied by EBOV PCR results in nonbloodstained cerebrospinal fluid samples (CSF) [2,3,4,5,6]. To define the full spectrum of characteristics and severity of neurologic and psychiatric disease, we investigated neurologic sequelae in patients with neurologic symptoms by providing specialist neurologic evaluation, psychiatric and disability assessment, and brain computed tomography (CT) imaging and retinal imaging to an EVD survivor cohort. Our additional objective was to describe psychiatric, disability, and ophthalmic outcomes for survivors with neurologic sequelae

Methods

Results

Conclusion