Neurologic and neuroimaging findings in COVID-19 patients: A retrospective multicenter study.

Kremer, Stéphane; Lersy, François; Anheim, Mathieu; Merdji, Hamid; Schenck, Maleka; Oesterlé, Hélène; Bolognini, Federico; Messie, Julien; Henri-Feugeas, Marie-Cécile; Khalil, Antoine; Gaudemer, Augustin; Carré, Sophie; Alleg, Manel; Lecocq, Claire; Schmitt, Emmanuelle; Anxionnat, René; Zhu, François; Jager, Lavinia; Nesser, Patrick; Mba, Yannick Talla; Hmeydia, Ghazi; Benzakoun, Joseph; Oppenheim, Catherine; Ferré, Jean-Christophe; Maamar, Adel; Carsin-Nicol, Béatrice; Comby, Pierre-Olivier; Ricolfi, Frédéric; Thouant, Pierre; Boutet, Claire; Fabre, Xavier; Forestier, Géraud; de Beaurepaire, Isaure; Bornet, Grégoire; Desal, Hubert; Boulouis, Grégoire; Berge, Jérome; Kazémi, Apolline; Pyatigorskaya, Nadya; Lecler, Augustin; Saleme, Suzana; Edjlali-Goujon, Myriam; Kerleroux, Basile; Constans, Jean Marc; Zorn, Pierre-Emmanuel; Mathieu, Muriel; Baloglu, Seyyid; Ardellier, François-Daniel; Willaume, Thibault; Brisset, Jean Christophe; Caillard, Sophie; Collange, Olivier; Mertes, Michel; Schneider, Francis; Fafi-Kremer, Samira; Ohana, Mickael; Meziani, Ferhat; Meyer, Nicolas; Helms, Julie; Cotton, François

OBJECTIVE To describe neuroimaging findings and to report the epidemiological and clinical characteristics of COVID-19 patients with neurological manifestations. METHODS In this retrospective multicenter study (10 Hospitals), we included 64 confirmed COVID-19 patients with neurologic manifestations who underwent a brain MRI. RESULTS The cohort included 43 men (67%), 21 women (33%), and the median age was 66 years (range: 20-92). 36 (56%) brain MRIs were considered abnormal, possibly related to SARS-CoV-2. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurological manifestation, following by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from the other patients with abnormal brain imaging since the former had less frequently acute respiratory distress syndrome (p=0·006) and more frequently corticospinal tract signs (p=0·02). Patients with encephalitis were younger (p=0·007), whereas agitation was more frequent for patients with leptomeningeal enhancement (p=0·009). CONCLUSIONS COVID-19 patients may develop a wide range of neurological symptoms, which can be associated with severe and fatal complications, such as ischemic stroke or encephalitis. Concerning the meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology rather seems to involve an immune and/or inflammatory process given the presence of signs of inflammation in both cerebrospinal fluid and neuroimaging but the lack of virus in cerebrospinal fluid.