Clinical description of the broad range of neurological presentations of COVID-19: a retrospective case series

de Langavant, Laurent Cleret; Petit, Aimée; Nguyen, Quang Tuan Rémy; Gendre, Thierry; Abdelhedi, Jihene; Djellaoui, Abdenour; Seddik, Lilia; Lim, Lydie; Faugeras, Frédéric; Salhi, Hayet; Wahab, Abir; Fechtenbaum, Laura; Dormeuil, Alice; Hosseini, Hassan; Youssov, Katia; Fénelon, Gilles; Bapst, Blanche; Brugières, Pierre; Tuilier, Titien; Kalsoum, Erwah; Matignon, Marie-Bénédicte; Oniszczuk, Julie; Gallien, Sébastien; Vindrios, William; Melica, Giovanna; Scain, Anne-Laure; Esser, Rémi; Rostain, Laura; Guillaud, Constance; Dubos-Lascu, Georgeta; Saada, Noémie; Guillet, Henri; Khellaf, Mehdi; Bardel, Benjamin; Ayache, Samar S; Lefaucheur, Jean-Pascal; Pawlotsky, Jean-Michel; Fourati, Slim; Bachoud-Lévi, Anne-Catherine

Background: Neurological disorders associated with SARS-CoV-2 infection represent a clinical challenge because they encompass a broad neurological spectrum and may occur before the diagnosis of COVID-19. Methods: In this monocentric retrospective case series, medical records from patients with acute neurological disorders associated with SARS-CoV-2 infection from medicine departments of an academic center in Paris area were collected between March 15th and May 15th 2020. Diagnosis of SARS-CoV-2 was ascertained through specific RT-PCR in nasopharyngeal swabs or based on circulating serum IgG antibodies. Results: Twenty-six patients diagnosed with SARS-CoV-2 infection presented with neurological disorders: encephalitis (N=8), encephalopathy (N=6), cerebrovascular events (ischemic strokes N=4 and vein thromboses N=2), other central nervous system (CNS) disorders (N=4), and Guillain-Barré syndrome (N=2). The diagnosis of SARS-CoV-2 was delayed on average 1.6 days after the onset of neurological disorder, especially in case of encephalitis 3.9 days, encephalopathy 1.0 day, and cerebrovascular event 2.7 days. Conclusions: Our study confirms that COVID-19 can yield a broad spectrum of neurological disorders. Because neurological presentations of COVID-19 often occur a few days before the diagnosis of SARS-COV-2 infection, clinicians should take preventive measures such as patient isolation and masks for any new admission to avoid nosocomial infections. Anti-SARS-CoV2 antibody detection in RT-PCR SARS CoV-2 negative suspected cases is useful to confirm a posteriori the diagnosis of atypical COVID-19 presentations.