Encephalopathy in patients with COVID-19: A review.

Garg, Ravindra Kumar; Paliwal, Vimal Kumar; Gupta, Ankit

Encephalopathy and encephalitis are major and devastating SARS-CoV-2 virus-associated CNS complications. Hypoxic/metabolic changes produced by intense inflammatory response against the virus triggers cytokine storm and subsequently ARDS and multiple organ failure. Hypoxic/metabolic changes result in encephalopathy. The presence of comorbidities predisposes to hypoxic/metabolic changes responsible for encephalopathy. Altered consciousness, ranging from mild confusion, delirium, to deep coma, is hallmark clinical features. Cortical and subcortical T2/FLAIR signal changes are common neuroimaging abnormalities. In a few isolated case reports of SARS-CoV-2 encephalitis, the virus has been demonstrated in CSF. The presence of anosmia and ageusia can help in differentiation from other encephalopathies. We analysed published reports on COVID-19 associated-encephalopathy. Encephalopathy is common in older patients, the majority are more than 50 years of age. The patients having encephalopathy/encephalitis are either severely or critically ill. Many patients were already on mechanical ventilation. Lung abnormalities are noted in almost all of the patients, presenting with encephalopathy. Encephalopathy is always preceded by commoner clinical features, like, fever, cough, dyspnoea, and headache. In majority, patients are already in the intensive care unit, when encephalopathy develops. This article is protected by copyright. All rights reserved.