Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study.
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Kremer Stéphane, Lersy François, Anheim Mathieu, Merdji Hamid, Schenck Maleka, Oesterlé Hélène, Bolognini Federico, Messie Julien, 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 Paul Michel, Schneider Francis, Fafi-Kremer Samira, Ohana Mickael, Meziani Ferhat, Meyer Nicolas, Helms Julie, Cotton François
Аннотация
METHODS: In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI.
RESULTS: The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20-92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed 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 that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome (p = 0.006) and more frequently had 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: Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF.
CLINICALTRIALSGOV IDENTIFIER: NCT04368390.