Central and peripheral nervous system complications of COVID-19 : a prospective tertiary center cohort with 3-month follow-up
© 2021. The Author(s)..
OBJECTIVE: To systematically describe central (CNS) and peripheral (PNS) nervous system complications in hospitalized COVID-19 patients.
METHODS: We conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission and discharge. Three-month follow-up data were collected using electronic health records. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related.
RESULTS: From April to September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom required intensive care (ICU) management for respiratory failure. Forty-one CNS/PNS complications were identified in 28 of 61 (45.9%) patients and were more frequent in ICU compared to non-ICU patients. The most common CNS complication was encephalopathy (n = 19, 31.1%), which was severe in 13 patients (GCS ≤ 12), including 8 with akinetic mutism. Length of ICU admission was independently associated with encephalopathy (OR = 1.22). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR = 1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were para/post-infectious, 34 were secondary to critical illness or other causes, and 4 remained unresolved. Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated.
CONCLUSION: CNS and PNS complications were common in hospitalized COVID-19 patients, particularly in the ICU, and often attributable to critical illness. When COVID-19 was the primary cause for neurological disease, no signs of viral neurotropism were detected, but laboratory changes suggested autoimmune-mediated mechanisms.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:268 |
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| Enthalten in: |
Journal of neurology - 268(2021), 9 vom: 13. Sept., Seite 3086-3104 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nersesjan, Vardan [VerfasserIn] |
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| Links: |
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| Themen: |
COVID-19 |
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| Anmerkungen: |
Date Completed 13.08.2021 Date Revised 20.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00415-020-10380-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 041 | |a eng | ||
| 100 | 1 | |a Nersesjan, Vardan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Central and peripheral nervous system complications of COVID-19 |b a prospective tertiary center cohort with 3-month follow-up |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 13.08.2021 | ||
| 500 | |a Date Revised 20.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. The Author(s). | ||
| 520 | |a OBJECTIVE: To systematically describe central (CNS) and peripheral (PNS) nervous system complications in hospitalized COVID-19 patients | ||
| 520 | |a METHODS: We conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission and discharge. Three-month follow-up data were collected using electronic health records. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related | ||
| 520 | |a RESULTS: From April to September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom required intensive care (ICU) management for respiratory failure. Forty-one CNS/PNS complications were identified in 28 of 61 (45.9%) patients and were more frequent in ICU compared to non-ICU patients. The most common CNS complication was encephalopathy (n = 19, 31.1%), which was severe in 13 patients (GCS ≤ 12), including 8 with akinetic mutism. Length of ICU admission was independently associated with encephalopathy (OR = 1.22). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR = 1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were para/post-infectious, 34 were secondary to critical illness or other causes, and 4 remained unresolved. Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated | ||
| 520 | |a CONCLUSION: CNS and PNS complications were common in hospitalized COVID-19 patients, particularly in the ICU, and often attributable to critical illness. When COVID-19 was the primary cause for neurological disease, no signs of viral neurotropism were detected, but laboratory changes suggested autoimmune-mediated mechanisms | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Coronavirus | |
| 650 | 4 | |a Critical illness | |
| 650 | 4 | |a Encephalopathy | |
| 650 | 4 | |a Myelitis | |
| 650 | 4 | |a SARS-COV-2 | |
| 650 | 7 | |a RNA, Viral |2 NLM | |
| 700 | 1 | |a Amiri, Moshgan |e verfasserin |4 aut | |
| 700 | 1 | |a Lebech, Anne-Mette |e verfasserin |4 aut | |
| 700 | 1 | |a Roed, Casper |e verfasserin |4 aut | |
| 700 | 1 | |a Mens, Helene |e verfasserin |4 aut | |
| 700 | 1 | |a Russell, Lene |e verfasserin |4 aut | |
| 700 | 1 | |a Fonsmark, Lise |e verfasserin |4 aut | |
| 700 | 1 | |a Berntsen, Marianne |e verfasserin |4 aut | |
| 700 | 1 | |a Sigurdsson, Sigurdur Thor |e verfasserin |4 aut | |
| 700 | 1 | |a Carlsen, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Langkilde, Annika Reynberg |e verfasserin |4 aut | |
| 700 | 1 | |a Martens, Pernille |e verfasserin |4 aut | |
| 700 | 1 | |a Lund, Eva Løbner |e verfasserin |4 aut | |
| 700 | 1 | |a Hansen, Klaus |e verfasserin |4 aut | |
| 700 | 1 | |a Jespersen, Bo |e verfasserin |4 aut | |
| 700 | 1 | |a Folke, Marie Norsker |e verfasserin |4 aut | |
| 700 | 1 | |a Meden, Per |e verfasserin |4 aut | |
| 700 | 1 | |a Hejl, Anne-Mette |e verfasserin |4 aut | |
| 700 | 1 | |a Wamberg, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Benros, Michael E |e verfasserin |4 aut | |
| 700 | 1 | |a Kondziella, Daniel |e verfasserin |4 aut | |
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