Neurological manifestations associated with COVID-19: a nationwide registry

Meppiel, E.; Peiffer-Smadja, N.; Maury, A.; Bekri, I.; Delorme, C.; Desestret, V.; Gorza, L.; Hautecloque-Raysz, G.; Landre, S.; Lannuzel, A.; Moulin, S.; Perrin, P.; Petitgas, P.; Sellal, F.; Wang, A.; Tattevin, P.; de Broucker, T.; registry, contributors to the NeuroCOVID

Objective. To analyze the spectrum and characteristics of neurological manifestations associated with SARS-CoV-2 infection. Methods. We conducted a nationwide, multicentric, retrospective study during the French COVID-19 epidemic in March-April 2020. All COVID-19 patients with de novo neurological manifestations were eligible. Results. We included 222 COVID-19 patients with neurological manifestations from 46 centers throughout the country. Median age was 65 years (IQR 53-72), and 136 patients (61.3%) were male. COVID-19 was severe or critical in almost half of the patients (102, 45.2%). Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with positive SARS-CoV-2 PCR in 2 out of 75 tested (2.7%). The most common neurological diseases were COVID-19 associated encephalopathy (CAE, 67/222, 30.2%), acute ischemic cerebrovascular syndrome (AICS, 57/222, 25.7%), encephalitis (21/222, 9.5%), and Guillain-Barre Syndrome (GBS, 15/222, 6.8%). Neurological manifestations appeared after first COVID-19 symptoms with a median delay of 6 days in CAE, 7 days in encephalitis, 12 days in AICS and 18 days in GBS. Around 25% of CAE and AICS were inaugural and 30% of CAE and encephalitis were diagnosed after discontinuation of sedation. Less common manifestations were also described, including meningitis and cranial neuropathy. The median follow-up of the patients was 24 days, with a particularly high short-term mortality rate in patients with CAE and AICS (19/124, 15.3%). Interpretation. Neurological manifestations associated with COVID-19 mainly included CAE, AICS, encephalitis and GBS. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.