Encephalopathy and encephalitis during acute SARS-CoV-2 infection. Spanish Society of Neurology COVID-19 Registry

• Published in: Neurologia (Barcelona, Spain) Vol. 36; no. 2; p. 127
• Main Authors: Abenza Abildúa, M J, Atienza, S, Carvalho Monteiro, G, Erro Aguirre, M E, Imaz Aguayo, L, Freire Álvarez, E, García-Azorín, D, Gil-Olarte Montesinos, I, Lara Lezama, L B, Navarro Pérez, M P, Pérez Sánchez, J R, Romero Delgado, F, Serrano Serrano, B, Villarreal Vitorica, E, Ezpeleta Echávarri, D
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-03-2021
• Subjects: Adrenal Cortex Hormones - therapeutic use; Brain Diseases - epidemiology; Brain Diseases - etiology; Brain Diseases - virology; Cognition Disorders - epidemiology; Coma - epidemiology; Coma - etiology; Coma - virology; Comorbidity; COVID-19 - complications; COVID-19 - epidemiology; Electroencephalography; Encephalitis, Viral - epidemiology; Encephalitis, Viral - etiology; Encephalitis, Viral - virology; Epilepsy - epidemiology; Female; Humans; Hypertension - epidemiology; Immunoglobulins, Intravenous - therapeutic use; Magnetic Resonance Imaging; Male; Neuroimaging; Pandemics; Registries; Respiratory Distress Syndrome - epidemiology; Respiratory Distress Syndrome - etiology; Retrospective Studies; SARS-CoV-2 - isolation & purification; SARS-CoV-2 - pathogenicity; Spain - epidemiology; Stroke - epidemiology; Spain; COVID-19; Encephalitis; SARS-CoV2; Registro SEN; SARS-CoV-2; Encefalopatías; Encephalopathy; SEN registry; Encefalitis
• ISSN: 1578-1968
• DOI: 10.1016/j.nrl.2070.11.013

Since the beginning of the COVID-19 pandemic, the Spanish Society of Neurology has run a registry of patients with neurological involvement for the purpose of informing clinical neurologists. Encephalopathy and encephalitis were among the most frequently reported complications. In this study, we analyse the characteristics of these complications.
We conducted a retrospective, descriptive, observational, multicentre study of patients with symptoms compatible with encephalitis or encephalopathy, entered in the Spanish Society of Neurology's COVID-19 Registry from 17 March to 6 June 2020.
A total of 232 patients with neurological symptoms were registered, including 51 cases of encephalopathy or encephalitis (21.9%). None of these patients were healthcare professionals. The most frequent syndromes were mild or moderate confusion (33%) and severe encephalopathy or coma (9.8%). The mean time between onset of infection and onset of neurological symptoms was 8.02 days. Lumbar puncture was performed in 60.8% of patients, with positive PCR results for SARS-CoV-2 in only one case. Brain MRI studies were performed in 47% of patients, with alterations detected in 7.8% of these. EEG studies were performed in 41.3% of cases, detecting alterations in 61.9%.
Encephalopathy and encephalitis are among the complications most frequently reported in the registry. More than one-third of patients presented mild or moderate confusional syndrome. The mean time from onset of infection to onset of neurological symptoms was 8 days (up to 24hours earlier in women than in men). EEG was the most sensitive test in these patients, with very few cases presenting alterations in neuroimaging studies. All patients treated with boluses of corticosteroids or immunoglobulins progressed favourably.