The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings

Brain - Tập 143 Số 10 - Trang 3104-3120 - 2020
Ross W. Paterson1,2,3, Rachel Brown4,3, Laura Benjamin5,6, Ross Nortley3,7, Sarah Wiethoff8,3, Tehmina Bharucha9,10,11, Dipa Jayaseelan3,12, Guru Kumar1, Rhian Raftopoulos13, L. Zambreanu3,12, Vinojini Vivekanandam11, Anthony Khoo11, Ruth Geraldes14,7, Krishna Chinthapalli3,7, Elena Boyd7, Hatice Tuzlalı7, Gary Price11, Gerry Christofi11, Jasper M. Morrow11,3, Patricia McNamara11, Benjamin C. Mcloughlin11, Soon Tjin Lim11, Puja R. Mehta11, Viva Levee11, Stephen Keddie3, Wisdom Yong15, S. Anand Trip15,3, Alexander Foulkes3,12, Gary Hotton11, Thomas D. Miller16, Alex Everitt17, Christopher Carswell18,17, Nicholas Davies18, Michael Yoong19, David Attwell20, Jemeen Sreedharan13, Eli Silber13, Thomas K. Karikari3, Arvind Chandratheva5, Richard Perry5, Robert Simister5, Anna M. Checkley21, Nicky Longley21, Simon F. Farmer11, Francesco Carletti22, Catherine Houlihan11,23, Maria Thom3, Michael P. Lunn3, Jennifer Spillane24,11, Robin Howard24,11, Angela Vincent3,14, David J. Werring5, Chandrashekar Hoskote22, Hans Rolf Jäger22,3, Hadi Manji11,3, Michael S. Zandi11,3
1Darent Valley Hospital, Dartford, Kent, UK
2UK Dementia Research Institute, London, UK
3University College London, Queen Square, Institute of Neurology, London, UK
4UCL Institute of Immunity and Transplantation, London, UK
5Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
6University of Liverpool, Brain Infections Group, Liverpool, Merseyside, UK
7Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK
8Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, Tübingen, Germany
9Department of Biochemistry, University of Oxford, Oxford, UK
10Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit, Mahosot Hospital, Vientiane, Laos
11National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK
12Watford General Hospital, Watford, Hertfordshire, UK
13King’s College Hospital, Denmark Hill, London, UK
14University of Oxford, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
15Northwick Park Hospital, Harrow, London, UK
16Lister Hospital, Stevenage, Hertfordshire, UK
17Imperial College Healthcare NHS Trust, London, UK
18Chelsea and Westminster Hospital, London, UK
19Barts and The London NHS Trust, London, UK
20UCL, Department of Neuroscience, Physiology and Pharmacology, London, UK
21Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
22Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK
23UCL Division of Infection and Immunity, London, UK
24Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Tóm tắt

Abstract Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria. Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and (v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies. The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms that will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.

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Brain

Tập 143 Số 10

3104-3120

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