L Cleret de Langavant1, A Petit1, Q T R Nguyen1, T Gendre2, J Abdelhedi2, A Djellaoui2, L Seddik2, L Lim2, F Faugeras1, H Salhi2, A Wahab2, L Fechtenbaum2, A Dormeuil1, H Hosseini3, K Youssov1, G Fénelon1, B Bapst4, P Brugières4, T Tuilier4, E Kalsoum4, M-B Matignon5, J Oniszczuk5, S Gallien6, W Vindrios6, G Melica6, A-L Scain7, R Esser7, L Rostain8, C Guillaud9, G Dubos-Lascu9, N Saada9, H Guillet10, M Khellaf9, B Bardel11, S S Ayache11, J-P Lefaucheur11, J-M Pawlotsky12, S Fourati12, A-C Bachoud-Lévi1. 1. AP-HP, Centre de référence maladie de Huntington, service de neurologie, hôpital Henri-Mondor, Créteil, France; Université Paris-Est Créteil, faculté de médecine, Créteil, France; Département d'études cognitives, école normale supérieure, PSL University, Paris, France; Inserm U955, Institut Mondor de recherche biomédicale, équipe E01 NeuroPsychologie Interventionnelle, Créteil, France. 2. AP-HP, Centre de référence maladie de Huntington, service de neurologie, hôpital Henri-Mondor, Créteil, France. 3. AP-HP, Centre de référence maladie de Huntington, service de neurologie, hôpital Henri-Mondor, Créteil, France; Université Paris-Est Créteil, faculté de médecine, Créteil, France. 4. AP-HP, service de neuroradiologie, Imagerie Médicale, hôpital Henri-Mondor, Créteil, France. 5. AP-HP, service de néphrologie, hôpital Henri-Mondor, Créteil, France. 6. AP-HP, service d'immunologie clinique, hôpital Henri-Mondor, Créteil, France. 7. AP-HP, service de gériatrie, hôpital Henri-Mondor, Créteil, France. 8. AP-HP, service de cardiologie, hôpital Henri-Mondor, Créteil, France. 9. AP-HP, département d'Aval des Urgences, hôpital Henri-Mondor, Créteil, France. 10. AP-HP, unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, Créteil, France. 11. AP-HP, unité de Neurophysiologie Clinique, Service de Physiologie-Explorations Fonctionnelles, hôpital Henri-Mondor, Créteil, France; EA 4391, excitabilité nerveuse et therapeutique, Université Paris-Est-Créteil, Créteil, France. 12. AP-HP, département de virologie, hôpital Henri-Mondor, Créteil, France.
Abstract
BACKGROUND: Neurological disorders associated with SARS-CoV-2 infection represent a clinical challenge because they encompass a broad neurological spectrum and may occur before the diagnosis of COVID-19. METHODS: In this monocentric retrospective case series, medical records from patients with acute neurological disorders associated with SARS-CoV-2 infection from medicine departments of an academic center in Paris area were collected between March 15th and May 15th 2020. Diagnosis of SARS-CoV-2 was ascertained through specific RT-PCR in nasopharyngeal swabs or based on circulating serum IgG antibodies. RESULTS: Twenty-six patients diagnosed with SARS-CoV-2 infection presented with neurological disorders: encephalitis (N=8), encephalopathy (N=6), cerebrovascular events (ischemic strokes N=4 and vein thromboses N=2), other central nervous system (CNS) disorders (N=4), and Guillain-Barré syndrome (N=2). The diagnosis of SARS-CoV-2 was delayed on average 1.6 days after the onset of neurological disorder, especially in case of encephalitis 3.9 days, encephalopathy 1.0 day, and cerebrovascular event 2.7 days. CONCLUSIONS: Our study confirms that COVID-19 can yield a broad spectrum of neurological disorders. Because neurological presentations of COVID-19 often occur a few days before the diagnosis of SARS-COV-2 infection, clinicians should take preventive measures such as patient isolation and masks for any new admission to avoid nosocomial infections. Anti-SARS-CoV2 antibody detection in RT-PCR SARS CoV-2 negative suspected cases is useful to confirm a posteriori the diagnosis of atypical COVID-19 presentations.
BACKGROUND:Neurological disorders associated with SARS-CoV-2 infection represent a clinical challenge because they encompass a broad neurological spectrum and may occur before the diagnosis of COVID-19. METHODS: In this monocentric retrospective case series, medical records from patients with acute neurological disorders associated with SARS-CoV-2 infection from medicine departments of an academic center in Paris area were collected between March 15th and May 15th 2020. Diagnosis of SARS-CoV-2 was ascertained through specific RT-PCR in nasopharyngeal swabs or based on circulating serum IgG antibodies. RESULTS: Twenty-six patients diagnosed with SARS-CoV-2 infection presented with neurological disorders: encephalitis (N=8), encephalopathy (N=6), cerebrovascular events (ischemic strokes N=4 and vein thromboses N=2), other central nervous system (CNS) disorders (N=4), and Guillain-Barré syndrome (N=2). The diagnosis of SARS-CoV-2 was delayed on average 1.6 days after the onset of neurological disorder, especially in case of encephalitis 3.9 days, encephalopathy 1.0 day, and cerebrovascular event 2.7 days. CONCLUSIONS: Our study confirms that COVID-19 can yield a broad spectrum of neurological disorders. Because neurological presentations of COVID-19 often occur a few days before the diagnosis of SARS-COV-2 infection, clinicians should take preventive measures such as patient isolation and masks for any new admission to avoid nosocomial infections. Anti-SARS-CoV2 antibody detection in RT-PCR SARS CoV-2 negative suspected cases is useful to confirm a posteriori the diagnosis of atypical COVID-19 presentations.