The wide spectrum of neuropsychiatric complications in Covid-19 patients within a multidisciplinary hospital context

Delorme, C.; Houot, M.; Rosso, C.; Carvalho, S.; Nedelec, T.; Maatoug, R.; Pitron, V.; Gassama, S.; Sambin, S.; Bombois, S.; Herlin, B.; Ouvrard, G.; Bruneteau, G.; Hesters, A.; Gales, A. Z.; Millet, B.; Lamari, F.; Lehericy, S.; Navarro, V.; Rohaut, B.; Demeret, S.; Maisonobe, T.; Yger, M.; Degos, B.; Mariani, L.-L.; Bouche, C.; Dzierzynski, N.; Oquendo, B.; Ketz, F.; Nguyen, A.-H.; Kas, A.; Delattre, J.-Y.; Corvol, J.-C.

Objective: To describe the spectrum of neurological and psychiatric complications in patients with Covid-19 seen in a multidisciplinary center over six months. Methods: We conducted a retrospective, observational study on all patients showing neurological or psychiatric symptoms in the context of Covid-19 seen in the Department of Neurology and Psychiatry of the APHP-Sorbonne University. We collected demographic data, medical and treatment history, comorbidities, symptoms, date of onset, and severity of Covid-19 infection, neurological and psychiatric symptoms, neurological and psychiatric examination data and, when available, results from cerebrospinal fluid (CSF) analysis, brain magnetic resonance (MRI) imaging, 18-fluorodesoxyglucose-position emission computed tomography (FDG-PET/CT)), electroencephalography (EEG) and electroneuromyography (ENMG). Results: 245 patients were included in the analysis. One-hundred fourteen patients (47%) were admitted to the intensive care unit (ICU) and 10 (4%) died. The most frequently reported neuropsychiatric symptoms were motor deficit (41%), cognitive disturbance (35%), impaired consciousness (26%), psychiatric disturbance (24%), headache (20%) and behavioral disturbance (18%). The most frequent syndromes diagnosed were encephalopathy (43%), critical illness polyneuropathy and myopathy (26%), isolated psychiatric disturbance (18%), and cerebrovascular disorders (16%). No patients showed evidence of SARS-CoV-2 in their CSF. Encephalopathy was associated with greater age and higher risk of death. Critical illness neuromyopathy was associated with an extended stay in the ICU. Conclusions: The majority of the neuropsychiatric complications recorded could be imputed to critical illness, intensive care and systemic inflammation, which contrasts with the paucity of more direct SARS-CoV-2-related complications or post-infection disorders.