Neurological complications in critical patients with COVID-19

• Published in: Neurología (Barcelona, English ed. ) Vol. 35; no. 9; pp. 621 - 627
• Main Authors: Abenza-Abildúa, M.J., Ramírez-Prieto, M.T., Moreno-Zabaleta, R., Arenas-Valls, N., Salvador-Maya, M.A., Algarra-Lucas, C., Rojo Moreno-Arrones, B., Sánchez-Cordón, B., Ojeda-Ruíz de Luna, J., Jimeno-Montero, C., Navacerrada-Barrero, F.J., Borrue-Fernández, C., Malmierca-Corral, E., Ruíz-Seco, P., González-Ruano, P., Palmí-Cortés, I., Fernández-Travieso, J., Mata-Álvarez de Santullano, M., Almarcha-Menargues, M.L., Gutierrez-Gutierrez, G., Palacios Castaño, J.A., Alonso Esteban, R., Gonzalo-García, N., Pérez-López, C.
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01-11-2020; Sociedad Española de Neurología. Published by Elsevier España, S.L.U; Elsevier España
• Subjects: Acute Disease; Acute myopathy; Adult; Age Factors; Aged; Betacoronavirus; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - etiology; Confusion - epidemiology; Confusion - etiology; Coronavirus Infections - complications; Coronavirus Infections - epidemiology; COVID-19; Critical Care; Critical Illness; Critical patient; Encefalopatías; Encephalopathy; Female; Humans; Length of Stay - statistics & numerical data; Magnetic Resonance Imaging; Male; Middle Aged; Miopatía aguda; Muscular Diseases - epidemiology; Muscular Diseases - etiology; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Neuroimaging; Original; Paciente crítico; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - epidemiology; Retrospective Studies; SARS-CoV-2; SARS-CoV2; Spain - epidemiology; Spain; COVID-19; SARS-CoV2; SARS-CoV-2; Miopatía aguda; Acute myopathy; Encephalopathy; Paciente crítico; Encefalopatías; Critical patient
• ISSN: 2173-5808; 2173-5808
• DOI: 10.1016/j.nrleng.2020.07.012

We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission.
We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020.
We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P = 0.002; 95% CI, 4.032–6.022; OR).
Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.
Nos proponemos analizar las complicaciones neurológicas de los pacientes con infección grave por SARS-CoV2, que han requerido ingreso en Unidad de Cuidados Intensivos (UCI).
Estudio descriptivo retrospectivo, observacional, de pacientes consecutivos ingresado en UCI por infección respiratoria grave por SARS-CoV-2, desde el 1 de Abril hasta el 1 de Junio de 2020.
Registramos 30 pacientes con síntomas neurológicos, 21 hombres (72,40%), edad media: 57,41 años ± 11,61 desviación estándar (DE). Estancia media en UCI: 18,83 ± 14,33 DE. A nivel sindrómico: 28 pacientes (93,33%) con síndrome confusional agudo, 15 pacientes (50%) con patología neuromuscular, 5 (16,66%) cefalea, 4 (13,33%) con patología cerebrovascular, y 4 (13,33%) con encefalopatías/encefalitis. Punción lumbar normal en 6 pacientes (20%). La RMN craneal o TAC craneal mostró alteraciones en 20 casos (66,6%). Se realizó EEG en todos los pacientes (100%), alterado en 8 pacientes (26,66%). En 5 de los 15 pacientes con miopatía clínica se ha podido confirmar con ENMG. Hemos encontrado relación entre la mayor edad y los días de ingreso en UCI (P = 0,002, IC 95% 4,032-6,022; OR:).
La infección grave por COVID-19 afecta mayoritariamente a hombres, similar a lo descrito en otras series. La mitad de nuestros pacientes presentan una miopatía aguda, y casi la totalidad de los pacientes salen de la UCI con sindromes confusionales agudos, que evolucionan a la resolución completa, sin correlacionarse con los resultados del EEG o de pruebas de neuroimagen. La mayor edad sí se asocia con un mayor número de días de estancia en UCI.