Virginie Lambrecq1,2,3, Aurélie Hanin1, Esteban Munoz-Musat1,2,3, Lydia Chougar1,4,5, Salimata Gassama6, Cécile Delorme6, Louis Cousyn1,6,7, Alaina Borden2, Maria Damiano2,6, Valerio Frazzini1,2,6, Gilles Huberfeld2,3, Frank Landgraf2, Vi-Huong Nguyen-Michel2, Phintip Pichit2,6, Aude Sangare1,2, Mario Chavez1, Capucine Morélot-Panzini8,9, Elise Morawiec8,9, Mathieu Raux1,10,11, Charles-Edouard Luyt12,13,14, Pierre Rufat15, Damien Galanaud1,4,5, Jean-Christophe Corvol1,6, Catherine Lubetzki1,6,7, Benjamin Rohaut1,6,7, Sophie Demeret6, Nadya Pyatigorskaya1,4,5, Lionel Naccache1,2,3, Vincent Navarro1,2,6,7,16. 1. Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France. 2. Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France. 3. Neurophysiology Department, Sorbonne Université, Paris, France. 4. Neuroradiology Department, Sorbonne Université, Paris, France. 5. Assistance Publique des Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France. 6. Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France. 7. Neurology Department, Sorbonne Université, Paris, France. 8. Service de Pneumologie, Sorbonne Université, Paris, France. 9. Assistance Publique des Hôpitaux de Paris, Service de Pneumologie, Médecine Intensive et Réanimation, Pitié-Salpêtrière Hospital, Paris, France. 10. Department of Anesthesia, Critical Care and Peri-Operative Medicine, Sorbonne Université, Paris, France. 11. Assistance Publique des Hôpitaux de Paris, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Paris, France. 12. Institut de Cardiologie, Sorbonne Université, Paris, France. 13. Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche, 1166-Institute of Cardiometabolism and Nutrition, Paris, France. 14. Assistance Publique des Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Institut de Cardiologie, Pitié-Salpêtrière Hospital, Paris, France. 15. Assistance Publique des Hôpitaux de Paris, Biostatistic Department, Pitié-Salpêtrière Hospital, Paris, France. 16. Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France.
Abstract
Importance: There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. Objectives: To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. Design, Setting, and Participants: This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. Exposures: Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. Main Outcomes and Measures: Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. Results: Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. Conclusions and Relevance: The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy.
Importance: There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. Objectives: To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. Design, Setting, and Participants: This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. Exposures: Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. Main Outcomes and Measures: Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. Results: Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. Conclusions and Relevance: The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy.
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