Neurologic manifestations associated with COVID-19: a multicentre registry

To provide an overview of the spectrum, characteristics and outcomes of neurologic manifestations associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a single-centre retrospective study during the French coronavirus disease 2019 (COVID-19) epidemic in...

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Published in:	Clinical microbiology and infection Vol. 27; no. 3; pp. 458 - 466
Main Authors:	Meppiel, Elodie, Peiffer-Smadja, Nathan, Maury, Alexandra, Bekri, Imen, Delorme, Cécile, Desestret, Virginie, Gorza, Lucas, Hautecloque-Raysz, Geoffroy, Landre, Sophie, Lannuzel, Annie, Moulin, Solène, Perrin, Peggy, Petitgas, Paul, SellaI, François, Wang, Adrien, Tattevin, Pierre, de Broucker, Thomas, Abgrall, Sophie, Alby-Laurent, Fanny, Allou, Thibault, Amevigbe, Joséphine, Amarguellay, Hanifa, Alloussi, Nabil, Baille, Guillaume, Barbaz, Mathilde, Bencherif, Lamia, Bensaadi, Samia, Beraud, Guillaume, Bizot, Alexandra, Bottin, Laure, Bruneel, Fabrice, Camdessanche, Jean-Philippe, Chauffier, Jeanne, Csajaghy, Jean-Philippe, De Broucker, Chloé, De Broucker, Thomas, Defebvre, Luc, Dembloque, Elodie, Derache, Nathalie, Dereeper, Olivier, Derollez, Céline, Descotes-Genon, Cécile, Devaux, Mathilde, Dubuc, Lydie, Edan, Gilles, Fickl, Andréa, Fraisse, Thibault, Gugenheim, Michel, Hankiewicz, Karolina, Hansmann, Yves, Henry, Carole, Jobard, Stéphanie, Jouan, Fanny, Kwiatkowski, Arnaud, Lalu, Thibault, Leguilloux, Johan, Lejeune, Camille, Liegeois, Clémence, Mahy, Sophie, Marey, Jonathan, Michel, Laure, Mitri, Rita, Moulin, Chloé, Omarjee, Asma, Ozsancak, Canan, Pico, Fernando, Poupard, Marie, Rabier, Valérie, Rizzato, Camille, Roos, Caroline, Saison, Julien, Sayre, Naomi, Sedillot, Nicolas, Sellal, François, Servan, Jérôme, Storey, Caroline, Suchet, Laurent, Tarteret, Paul, Thiebaut, Mathilde, Vaduva, Claudia, Varlan, David, Zarrouk, Virginie
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-03-2021 Elsevier for the European Society of Clinical Microbiology and Infectious Diseases European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd
Subjects:	Aged Brain - diagnostic imaging Brain - pathology COVID-19 COVID-19 - complications COVID-19 - epidemiology Female France - epidemiology Humans Life Sciences Male Middle Aged Nervous system Nervous System Diseases - diagnosis Nervous System Diseases - epidemiology Nervous System Diseases - etiology Nervous System Diseases - pathology Neurologic manifestations Original Registries - statistics & numerical data Registry Retrospective Studies SARS-CoV-2 France COVID-19 Nervous system Neurologic manifestations SARS-CoV-2 Registry
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Summary:	To provide an overview of the spectrum, characteristics and outcomes of neurologic manifestations associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a single-centre retrospective study during the French coronavirus disease 2019 (COVID-19) epidemic in March–April 2020. All COVID-19 patients with de novo neurologic manifestations were eligible. We included 222 COVID-19 patients with neurologic manifestations from 46 centres in France. Median (interquartile range, IQR) age was 65 (53–72) years and 136 patients (61.3%) were male. COVID-19 was severe or critical in 102 patients (45.2%). The most common neurologic 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%). Neurologic manifestations appeared after the 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 magnetic resonance imaging (70.7%). Among patients with acute ischaemic cerebrovascular syndrome, 13 (22.8%) of 57 had multiterritory ischaemic strokes, with large vessel thrombosis in 16 (28.1%) of 57. Brain magnetic resonance imaging of encephalitis patients showed heterogeneous acute nonvascular lesions in 14 (66.7%) of 21. Cerebrospinal fluid of 97 patients (43.7%) was analysed, with pleocytosis found in 18 patients (18.6%) and a positive SARS-CoV-2 PCR result in two patients with encephalitis. The median (IQR) follow-up was 24 (17–34) days with a high short-term mortality rate (28/222, 12.6%). Clinical spectrum and outcomes of neurologic manifestations associated with SARS-CoV-2 infection were broad and heterogeneous, suggesting different underlying pathogenic processes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 PMCID: PMC7661948 Contributors to the French NeuroCOVID registry are listed in Supplementary Appendix S2.
ISSN:	1198-743X 1469-0691
DOI:	10.1016/j.cmi.2020.11.005