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J Clin Neurophysiol ; 38(3): e11-e13, 2021 May 01.
Article in English | MEDLINE | ID: covidwho-910348


SUMMARY: A 78-year-old man was admitted for acute confusion. At initial investigation physical examination, blood and cerebrospinal fluid tests were unremarkable and EEG showed synchronous bifrontal periodic discharges, an evocative pattern of encephalitis. Coronavirus disease 2019 was diagnosed later after fever onset. Isolated mild confusion may thus be an initial clinical picture of Coronavirus disease 2019 infection.

COVID-19/diagnosis , Confusion/diagnosis , Electroencephalography/methods , Encephalitis/diagnosis , Aged , COVID-19/physiopathology , COVID-19/psychology , Confusion/physiopathology , Confusion/psychology , Diagnosis, Differential , Encephalitis/physiopathology , Encephalitis/psychology , Humans , Male
J Psychiatr Res ; 130: 215-217, 2020 11.
Article in English | MEDLINE | ID: covidwho-713999


Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, is a disaster due to not only its psychosocial impact but it also to its direct effects on the brain. The latest evidence suggests it has neuroinvasive mechanisms, in addition to neurological manifestations, and as seen in past pandemics, long-term sequelae are expected. Specific and well-structured interventions are necessary, and that's why it's important to ensure a continuity between primary care, emergency medicine, and psychiatry. Evidence shows that 2003 SARS (Severe Acute Respiratory Syndrome) survivors developed persistent psychiatric comorbidities after the infection, in addition to Chronic Fatigue Syndrome. A proper stratification of patients according not only to psychosocial factors but also an inflammatory panel and SARS-Cov-2's direct effects on the central nervous system (CNS) and the immune system, may improve outcomes. The complexity of COVID-19's pathology and the impact on the brain requires appropriate screening that has to go beyond the psychosocial impact, taking into account how stress and neuroinflammation affects the brain. This is a call for a clinical multidisciplinary approach to treat and prevent Sars-Cov-2 mental health sequelae.

Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/psychology , Mental Disorders/complications , Mental Disorders/psychology , Neurosciences/methods , Pneumonia, Viral/complications , Pneumonia, Viral/psychology , COVID-19 , Encephalitis/complications , Encephalitis/prevention & control , Encephalitis/psychology , Humans , Mental Disorders/prevention & control , Pandemics , SARS-CoV-2 , Stress, Physiological
J Neurol ; 268(3): 751-757, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-688846


BACKGROUND: Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore investigated clinical, serological and CSF features of coronavirus disease 2019 (COVID-19) patients with neurological manifestations. METHODS: Consecutive COVID-19 patients with neurological manifestations other than isolated anosmia and/or non-severe headache, and with no previous neurological or psychiatric disorders were prospectively included. Neurological examination was performed in all patients and lumbar puncture with CSF examination was performed when not contraindicated. Serum anti-gangliosides antibodies were tested when clinically indicated. RESULTS: Of the 349 COVID-19 admitted to our center between March 23rd and April 24th 2020, 15 patients (4.3%) had neurological manifestations and fulfilled the study inclusion/exclusion criteria. CSF examination was available in 13 patients and showed lymphocytic pleocytosis in 2 patients: 1 with anti-contactin-associated protein 2 (anti-Caspr2) antibody encephalitis and 1 with meningo-polyradiculitis. Increased serum titer of anti-GD1b antibodies was found in three patients and was associated with variable clinical presentations, including cranial neuropathy with meningo-polyradiculitis, brainstem encephalitis and delirium. CSF PCR for SARS-CoV-2 was negative in all patients. CONCLUSIONS: In SARS-Cov-2 infected patients with neurological manifestations, CSF pleocytosis is associated with para- or post-infectious encephalitis and polyradiculitis. Anti-GD1b and anti-Caspr2 autoantibodies can be identified in certain cases, raising the question of SARS-CoV-2-induced secondary autoimmunity.

COVID-19/complications , Nervous System Diseases/etiology , Nervous System Diseases/immunology , Adult , Aged , Aged, 80 and over , Antibodies/cerebrospinal fluid , COVID-19/cerebrospinal fluid , Delirium/etiology , Delirium/psychology , Encephalitis/etiology , Encephalitis/psychology , Female , Gangliosides/immunology , Humans , Leukocytosis/cerebrospinal fluid , Male , Membrane Proteins/cerebrospinal fluid , Middle Aged , Nerve Tissue Proteins/cerebrospinal fluid , Nervous System Diseases/cerebrospinal fluid , Neurologic Examination , Radiculopathy/etiology , Radiculopathy/psychology , Spinal Puncture