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The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings.
Brain. 2020 10 01; 143(10):3104-3120.B

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.

Authors+Show Affiliations

University College London, Queen Square Institute of Neurology, London, UK. Darent Valley Hospital, Dartford, Kent, UK. UK Dementia Research Institute, London, UK.University College London, Queen Square Institute of Neurology, London, UK. UCL Institute of Immunity and Transplantation, London, UK.Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK. University of Liverpool, Brain Infections Group, Liverpool, Merseyside, UK.University College London, Queen Square Institute of Neurology, London, UK. Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK.University College London, Queen Square Institute of Neurology, London, UK. Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, Tübingen, Germany.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK. Department of Biochemistry, University of Oxford, Oxford, UK. Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit, Mahosot Hospital, Vientiane, Laos.University College London, Queen Square Institute of Neurology, London, UK. Watford General Hospital, Watford, Hertfordshire, UK.Darent Valley Hospital, Dartford, Kent, UK.King's College Hospital, Denmark Hill, London, UK.University College London, Queen Square Institute of Neurology, London, UK. Watford General Hospital, Watford, Hertfordshire, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK. University of Oxford, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.University College London, Queen Square Institute of Neurology, London, UK. Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK.Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK.Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.University College London, Queen Square Institute of Neurology, London, UK. National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.University College London, Queen Square Institute of Neurology, London, UK.Northwick Park Hospital, Harrow, London, UK.University College London, Queen Square Institute of Neurology, London, UK. Northwick Park Hospital, Harrow, London, UK.University College London, Queen Square Institute of Neurology, London, UK. Watford General Hospital, Watford, Hertfordshire, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.Lister Hospital, Stevenage, Hertfordshire, UK.Imperial College Healthcare NHS Trust, London, UK.Imperial College Healthcare NHS Trust, London, UK. Chelsea and Westminster Hospital, London, UK.Chelsea and Westminster Hospital, London, UK.Barts and The London NHS Trust, London, UK.UCL, Department of Neuroscience, Physiology and Pharmacology, London, UK.King's College Hospital, Denmark Hill, London, UK.King's College Hospital, Denmark Hill, London, UK.University College London, Queen Square Institute of Neurology, London, UK.Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK. UCL Division of Infection and Immunity, London, UK.University College London, Queen Square Institute of Neurology, London, UK.University College London, Queen Square Institute of Neurology, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK. Guy's and St Thomas' NHS Foundation Trust, London, UK.National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK. Guy's and St Thomas' NHS Foundation Trust, London, UK.University College London, Queen Square Institute of Neurology, London, UK. University of Oxford, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.University College London, Queen Square Institute of Neurology, London, UK. Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.University College London, Queen Square Institute of Neurology, London, UK. National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.University College London, Queen Square Institute of Neurology, London, UK. National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32637987

Citation

Paterson, Ross W., et al. "The Emerging Spectrum of COVID-19 Neurology: Clinical, Radiological and Laboratory Findings." Brain : a Journal of Neurology, vol. 143, no. 10, 2020, pp. 3104-3120.
Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020;143(10):3104-3120.
Paterson, R. W., Brown, R. L., Benjamin, L., Nortley, R., Wiethoff, S., Bharucha, T., Jayaseelan, D. L., Kumar, G., Raftopoulos, R. E., Zambreanu, L., Vivekanandam, V., Khoo, A., Geraldes, R., Chinthapalli, K., Boyd, E., Tuzlali, H., Price, G., Christofi, G., Morrow, J., ... Zandi, M. S. (2020). The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain : a Journal of Neurology, 143(10), 3104-3120. https://doi.org/10.1093/brain/awaa240
Paterson RW, et al. The Emerging Spectrum of COVID-19 Neurology: Clinical, Radiological and Laboratory Findings. Brain. 2020 10 1;143(10):3104-3120. PubMed PMID: 32637987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. AU - Paterson,Ross W, AU - Brown,Rachel L, AU - Benjamin,Laura, AU - Nortley,Ross, AU - Wiethoff,Sarah, AU - Bharucha,Tehmina, AU - Jayaseelan,Dipa L, AU - Kumar,Guru, AU - Raftopoulos,Rhian E, AU - Zambreanu,Laura, AU - Vivekanandam,Vinojini, AU - Khoo,Anthony, AU - Geraldes,Ruth, AU - Chinthapalli,Krishna, AU - Boyd,Elena, AU - Tuzlali,Hatice, AU - Price,Gary, AU - Christofi,Gerry, AU - Morrow,Jasper, AU - McNamara,Patricia, AU - McLoughlin,Benjamin, AU - Lim,Soon Tjin, AU - Mehta,Puja R, AU - Levee,Viva, AU - Keddie,Stephen, AU - Yong,Wisdom, AU - Trip,S Anand, AU - Foulkes,Alexander J M, AU - Hotton,Gary, AU - Miller,Thomas D, AU - Everitt,Alex D, AU - Carswell,Christopher, AU - Davies,Nicholas W S, AU - Yoong,Michael, AU - Attwell,David, AU - Sreedharan,Jemeen, AU - Silber,Eli, AU - Schott,Jonathan M, AU - Chandratheva,Arvind, AU - Perry,Richard J, AU - Simister,Robert, AU - Checkley,Anna, AU - Longley,Nicky, AU - Farmer,Simon F, AU - Carletti,Francesco, AU - Houlihan,Catherine, AU - Thom,Maria, AU - Lunn,Michael P, AU - Spillane,Jennifer, AU - Howard,Robin, AU - Vincent,Angela, AU - Werring,David J, AU - Hoskote,Chandrashekar, AU - Jäger,Hans Rolf, AU - Manji,Hadi, AU - Zandi,Michael S, PY - 2020/06/01/received PY - 2020/06/29/revised PY - 2020/06/30/accepted PY - 2020/7/9/pubmed PY - 2020/11/11/medline PY - 2020/7/9/entrez KW - ADEM KW - COVID-19 KW - SARS-CoV-2 KW - encephalitis SP - 3104 EP - 3120 JF - Brain : a journal of neurology JO - Brain VL - 143 IS - 10 N2 - 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. SN - 1460-2156 UR - https://www.unboundmedicine.com/medline/citation/32637987/The_emerging_spectrum_of_COVID_19_neurology:_clinical_radiological_and_laboratory_findings_ L2 - https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awaa240 DB - PRIME DP - Unbound Medicine ER -