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.
Competing Interest Statement
The authors have declared no competing interest.
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
In accordance with French law, the study complied with the Commission Nationale de l Informatique et des Libertes (CNIL, reference number 2217844) and ethics committee (reference number RCB 2020-A01300-39) requirements. The IRB CER-MIT number 2020-0602 COVID has approved the study.
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
The data that support the findings of this study are available on request from the corresponding author, EM. The data are not publicly available due to information that could compromise the privacy of research participants.