Weixi Xiong1, Jie Mu1, Jian Guo1, Lu Lu1, Dan Liu1, Jianfei Luo1, Nian Li1, Jing Liu1, Dan Yang1, Hui Gao1, Yingying Zhang1, Mintao Lin1, Sisi Shen1, Hesheng Zhang1, Lei Chen1, Gang Wang1, Fengming Luo1, Weimin Li1, Shengli Chen1, Li He1, Josemir W Sander1, Dong Zhou2. 1. From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands. 2. From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands. zhoudong66@yahoo.de.
Abstract
OBJECTIVE: To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19). METHODS: A retrospective multicenter cohort study was conducted between January 18 and March 20, 2020, including people with confirmed COVID-19 from 56 hospitals officially designated in 3 Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination, and investigations were noted, in which critical events included disorders of consciousness, stroke, CNS infection, seizures, and status epilepticus. RESULTS: We enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new-onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n = 25) or stroke (n = 10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurologic conditions. Noncritical events were seen in fewer than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic, and tremor. Brain CT in 28 people led to new findings in 9. Findings from lumbar puncture in 3 with suspected CNS infection, unexplained headache, or severe occipital neuralgia were unremarkable. CONCLUSIONS: People with COVID-19 aged over 60 and with neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of severe acute respiratory syndrome coronavirus 2 to the CNS is lacking.
OBJECTIVE: To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19). METHODS: A retrospective multicenter cohort study was conducted between January 18 and March 20, 2020, including people with confirmed COVID-19 from 56 hospitals officially designated in 3 Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination, and investigations were noted, in which critical events included disorders of consciousness, stroke, CNS infection, seizures, and status epilepticus. RESULTS: We enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new-onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n = 25) or stroke (n = 10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurologic conditions. Noncritical events were seen in fewer than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic, and tremor. Brain CT in 28 people led to new findings in 9. Findings from lumbar puncture in 3 with suspected CNS infection, unexplained headache, or severe occipital neuralgia were unremarkable. CONCLUSIONS:People with COVID-19 aged over 60 and with neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of severe acute respiratory syndrome coronavirus 2 to the CNS is lacking.
Authors: Sean T Hwang; Ahmad A Ballout; Anup N Sonti; Amitha Kapyur; Claudia Kirsch; Neeraj Singh; Noah Markowitz; Tung Ming Leung; Derek J Chong; Richard Temes; Steven V Pacia; Ruben I Kuzniecky; Souhel Najjar Journal: Neurol Clin Pract Date: 2022-02
Authors: Pedro Renato P Brandão; Talyta C Grippe; Danilo A Pereira; Renato P Munhoz; Francisco Cardoso Journal: Tremor Other Hyperkinet Mov (N Y) Date: 2021-07-08
Authors: Jennifer A Frontera; Sakinah Sabadia; Rebecca Lalchan; Taolin Fang; Brent Flusty; Patricio Millar-Vernetti; Thomas Snyder; Stephen Berger; Dixon Yang; Andre Granger; Nicole Morgan; Palak Patel; Josef Gutman; Kara Melmed; Shashank Agarwal; Matthew Bokhari; Andres Andino; Eduard Valdes; Mirza Omari; Alexandra Kvernland; Kaitlyn Lillemoe; Sherry H-Y Chou; Molly McNett; Raimund Helbok; Shraddha Mainali; Ericka L Fink; Courtney Robertson; Michelle Schober; Jose I Suarez; Wendy Ziai; David Menon; Daniel Friedman; David Friedman; Manisha Holmes; Joshua Huang; Sujata Thawani; Jonathan Howard; Nada Abou-Fayssal; Penina Krieger; Ariane Lewis; Aaron S Lord; Ting Zhou; D Ethan Kahn; Barry M Czeisler; Jose Torres; Shadi Yaghi; Koto Ishida; Erica Scher; Adam de Havenon; Dimitris Placantonakis; Mengling Liu; Thomas Wisniewski; Andrea B Troxel; Laura Balcer; Steven Galetta Journal: Neurology Date: 2020-10-05 Impact factor: 9.910