Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 25
Filter
1.
BMJ Case Rep ; 15(11)2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2097947

ABSTRACT

Loeys-Dietz syndrome (LDS) is a rare, autosomal dominant multisystem disorder that is caused by mutations of transforming growth factor-ß receptors. Mutations in SMAD3 and TGFB3 have been recently reported.LDS is characterised by the triad of arterial tortuosity, hypertelorism and a bifid uvula or cleft palate among other cardiovascular, craniofacial and orthopaedic manifestations. Patients with LDS show clinical and genetic variability and there is a significant risk of reduced life expectancy due to widespread arterial involvement, aortic root dilation, aneurysms and an aggressive vascular course. Thus early genetic testing is warranted if clinical signs and history are suggestive of this potentially catastrophic disorder.LDS predisposes patients to aortic aneurysms and early death due to vascular malformations, but neurological emergencies, such as seizures and febrile status epilepticus, have not been reported.Febrile status epilepticus is the most common neurological emergency in childhood. Neurological manifestations of COVID-19 in the paediatric population are not as well described in medical literature.To the best of our knowledge, this is the first reported case of febrile status epilepticus with COVID-19 infection in an infant with LDS. Our patient had focal epileptiform activity emanating over the left posterior hemisphere, which evolved into an electrographic seizure on video EEG. Such patients have a heightened risk of epilepsy in the future, and this occurrence is consistent with a diagnosis of focal epilepsy. Neurological complications such as epilepsy and status epilepticus in a patient with LDS have never been reported before.A brief review of literature is also given here.


Subject(s)
COVID-19 , Loeys-Dietz Syndrome , Status Epilepticus , Child , Infant , Humans , Loeys-Dietz Syndrome/complications , Loeys-Dietz Syndrome/diagnosis , Loeys-Dietz Syndrome/genetics , COVID-19/complications , Receptors, Transforming Growth Factor beta/genetics , Seizures , Status Epilepticus/etiology , Status Epilepticus/therapy
2.
BMC Neurol ; 22(1): 253, 2022 Jul 11.
Article in English | MEDLINE | ID: covidwho-1928163

ABSTRACT

BACKGROUND: Neurological manifestations of COVID-19 are thought to be associated with the disease severity of COVID-19 and poor clinical outcomes. Dysregulated immune responses are considered to be mediating such complications. Our case illustrates multiple critical neurological complications simultaneously developed in a patient with non-severe COVID-19 and successful recovery with a multifaceted therapeutic approach. The cerebrospinal fluid (CSF) interleukin-6 (IL-6) level was temporally correlated with the clinical severity of the status epilepticus in our patient, suggesting a causal relationship. CASE PRESENTATION: A previously healthy 20-year-old female patient presented with a first-onset seizure. Concomitant non-severe COVID-19 pneumonia was diagnosed. CSF study showed lymphocytic pleocytosis with elevated IL-6 levels in CSF. During hospitalization under the diagnosis of autoimmune encephalitis, status epilepticus developed, and the seizure frequency was temporally correlated with the CSF IL-6 level. Furthermore, a new embolic stroke developed without a significant cardioembolic source. Contrary to the exacerbated COVID-19-associated neurological complications, COVID-19 pneumonia was cleared entirely. After treatment with antiseizure medications, antithrombotics, antiviral agents, and immunotherapy, the patient was discharged with near-complete recovery. CONCLUSION: Active serological, and radiological evaluation can be helpful even in non-severe COVID-19, and multidimensional treatment strategies, including immunotherapy, can successfully reverse the neurological complication.


Subject(s)
COVID-19 , Encephalitis , Status Epilepticus , Stroke , Adult , COVID-19/complications , Female , Humans , Interleukin-6 , Seizures/drug therapy , Status Epilepticus/diagnosis , Status Epilepticus/drug therapy , Status Epilepticus/etiology , Stroke/etiology , Stroke/therapy , Young Adult
3.
J Neurol ; 269(11): 5710-5719, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1926025

ABSTRACT

BACKGROUND: The "coronavirus disease 2019" (COVID-19) pandemic, caused by the "severe-acute-respiratory-syndrome-coronavirus 2" (SARS-CoV-2), challenges healthcare systems worldwide and impacts not only COVID-19 patients but also other emergencies. To date, data are scarce on the extent to which the COVID-19 pandemic impacted status epilepticus (SE) and its treatment. OBJECTIVE: To assess the influence of the COVID-19 pandemic on the incidence, management and outcome of SE patients. STUDY DESIGN: This is a retrospective, multicentre trial, approved by the University of Cologne (21-1443-retro). METHODS: All SE patients from the urban area of Cologne transmitted to all acute neurological departments in Cologne between 03/2019 and 02/2021 were retrospectively analysed and assessed for patient characteristics, SE characteristics, management, and outcome in the first pandemic year compared to the last pre-pandemic year. RESULTS: 157 pre-pandemic (03/2019-02/2020) and 171 pandemic (from 03/2020 to 02/2021) SE patients were included in the analyses. Acute SARS-CoV-2 infections were rarely detected. Patient characteristics, management, and outcome did not reveal significant groupwise differences. In contrast, regarding prehospital management, a prolonged patient transfer to the hospital and variations in SE aetiologies compared to the last pre-pandemic year were observed with less chronic vascular and more cryptogenic and anoxic SE cases. No infections with SARS-CoV-2 occurred during inpatient stays. CONCLUSIONS: SARS-CoV-2 infections did not directly affect SE patients, but the transfer of SE patients to emergency departments was delayed. Interestingly, SE aetiology rates shifted, which warrants further exploration. Fears of contracting an in-hospital SARS-CoV-2-infection were unfounded due to consequent containment measures.


Subject(s)
COVID-19 , Status Epilepticus , Germany/epidemiology , Humans , Pandemics , Registries , Retrospective Studies , SARS-CoV-2 , Status Epilepticus/epidemiology , Status Epilepticus/etiology , Status Epilepticus/therapy
4.
Acta Biomed ; 93(3): e2022075, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1924891
5.
Eur J Neurol ; 29(9): 2861-2863, 2022 09.
Article in English | MEDLINE | ID: covidwho-1883192

ABSTRACT

BACKGROUND AND PURPOSE: COVID-19 is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in which neurological complications have been increasingly recognized. Acute symptomatic epileptic seizures and status epilepticus are frequently reported neurological complications associated with this infection. The nervous system damage caused by SARS-CoV-2 may be mediated by the immune system. Interleukin 6 (IL-6), an important component of the cytokine storm, is directly correlated with the severity of symptoms. Tocilizumab is an inhibitor of IL-6 receptors, which blocks IL-6-mediated signal transduction and is used in the treatment of COVID-19 and status epilepticus. CASE REPORT: A patient with the Unverricht-Lundborg disease is presented who had developed refractory recurrent status epilepticus during COVID-19 infection, which was finally controlled by treatment with tocilizumab. DISCUSSION: Tocilizumab, an IL-6 inhibitor, may be considered as a treatment option in patients with status epilepticus and refractory seizures.


Subject(s)
COVID-19 , Status Epilepticus , Antibodies, Monoclonal, Humanized , COVID-19/complications , COVID-19/drug therapy , Humans , Interleukin-6 , SARS-CoV-2 , Status Epilepticus/drug therapy , Status Epilepticus/etiology
6.
Epilepsia ; 63(8): e86-e91, 2022 08.
Article in English | MEDLINE | ID: covidwho-1832048

ABSTRACT

We are reporting 16 pediatric patients (ages 0-18-years-old) who presented to our urban hospital emergency room with seizures and coronavirus disease 2019 (COVID-19) during the surge of the Omicron variant. There was an increased number of pediatric patients with seizures and COVID-19 during this period as compared to prior COVID-19 surges. The 16 patients ranged in age from 3 months to 12 years of age. Five of the 16 patients (31%) had a prior history of epilepsy. Eight patients (50%) presented in status epilepticus, and in six patients (38%) the seizures appeared to have focal features. Fourteen patients (88%) presented with a complex provoked seizure defined as exhibiting either focality, seizure >5 min in length, or more than one seizure in 24 h. We suggest that in the pediatric population, when compared to prior variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the Omicron variant is more likely to be associated with neurologic symptoms, including complex provoked seizures.


Subject(s)
COVID-19 , Status Epilepticus , Adolescent , COVID-19/complications , Child , Child, Preschool , Humans , Infant , Infant, Newborn , SARS-CoV-2 , Seizures/diagnosis , Seizures/epidemiology , Seizures/etiology , Status Epilepticus/diagnosis , Status Epilepticus/epidemiology , Status Epilepticus/etiology
7.
Epilepsia ; 63(7): 1778-1786, 2022 07.
Article in English | MEDLINE | ID: covidwho-1774791

ABSTRACT

OBJECTIVE: Vaccination against the SARS-CoV-2 virus is a primary tool to combat the COVID-19 pandemic. However, vaccination is a common seizure trigger in individuals with Dravet syndrome (DS). Information surrounding COVID-19 vaccine side effects in patients with DS would aid caregivers and providers in decisions for and management of COVID-19 vaccination. METHODS: A survey was emailed to the Dravet Syndrome Foundation's Family Network and posted to the Dravet Parent & Caregiver Support Group on Facebook between May and August 2021. Deidentified information obtained included demographics and vaccination status for individuals with DS. Vaccine type, side effects, preventative measures, and changes in seizure activity following COVID-19 vaccination were recorded. For unvaccinated individuals, caregivers were asked about intent to vaccinate and reasons for their decision. RESULTS: Of 278 survey responses, 120 represented vaccinated individuals with DS (median age = 19.5 years), with 50% reporting no side effects from COVID-19 vaccination. Increased seizures following COVID-19 vaccination were reported in 16 individuals, but none had status epilepticus. Of the 158 individuals who had not received a COVID-19 vaccination, 37 were older than 12 years (i.e., eligible at time of study), and only six of these caregivers indicated intent to seek vaccination. The remaining 121 responses were caregivers to children younger than 12 years, 60 of whom indicated they would not seek COVID-19 vaccination when their child with DS became eligible. Reasons for vaccine hesitancy were fear of increased seizure activity and concerns about vaccine safety. SIGNIFICANCE: These results indicate COVID-19 vaccination is well tolerated by individuals with DS. One main reason for vaccine hesitancy was fear of increased seizure activity, which occurred in only 13% of vaccinated individuals, and none had status epilepticus. This study provides critical and reassuring insights for caregivers and health care providers making decisions about the safety of COVID-19 vaccinations for individuals with DS.


Subject(s)
COVID-19 , Epilepsies, Myoclonic , Status Epilepticus , Adult , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Child , Epilepsies, Myoclonic/etiology , Epileptic Syndromes , Humans , Pandemics , SARS-CoV-2 , Seizures/etiology , Spasms, Infantile , Status Epilepticus/etiology , Vaccination/adverse effects , Young Adult
8.
Epilepsia ; 63(5): e51-e56, 2022 05.
Article in English | MEDLINE | ID: covidwho-1752541

ABSTRACT

Multisystem inflammatory syndrome in adults (MIS-A) is a rare hyperinflammatory complication with multi-organ involvement that manifests a few weeks after recovering from a typically mild coronavirus disease 2019 (COVID-19) infection. Although encephalopathy and seizures can occur in the acute phase of COVID-19, the nervous system is infrequently involved in patients with MIS-A. Herein, we describe the case of a young woman who presented with new-onset refractory status epilepticus (NORSE) following a mild COVID-19 infection associated with symptoms, signs, and laboratory findings that satisfy the updated Centers for Disease Control and Prevention (CDC) definition of MIS-A. Magnetic resonance imaging of the brain revealed symmetric T2-signal increase involving both orbitofrontal lobes, insulae, and hippocampi. One of the notable findings in our patient was the quick response and significant clinical recovery that occurred following initiation of treatment with intravenous methylprednisolone and intravenous immunoglobulin. Our case expands the clinical spectrum of MIS-A and documents the occurrence of NORSE as one of its early clinical manifestations. A routine comprehensive clinical and laboratory assessment is needed to screen for this underdiagnosed condition, especially in patients with post-COVID-19 inflammatory complications.


Subject(s)
COVID-19 , Status Epilepticus , Acute Disease , Adult , COVID-19/complications , Female , Humans , SARS-CoV-2 , Status Epilepticus/drug therapy , Status Epilepticus/etiology , Systemic Inflammatory Response Syndrome/complications
9.
Curr Neurol Neurosci Rep ; 22(1): 11-17, 2022 01.
Article in English | MEDLINE | ID: covidwho-1653759

ABSTRACT

PURPOSE OF REVIEW: Seizures, including status epilepticus, have been reported in association with acute COVID-19 infection. People with epilepsy (PWE) have suffered from seizure exacerbations during the pandemic. This article reviews the data for clinical and electrographic seizures associated with COVID-19, technical EEG considerations for reducing risk of transmission, and factors contributing to seizure exacerbations in PWE as well as strategies to address this issue. RECENT FINDINGS: An increasing number of studies of larger cohorts, accounting for a variety of variables and often utilizing EEG with standardized terminology, are assessing the prevalence of seizures in hospitalized patients with acute COVID-19 infections, and gaining insight into the prevalence of seizures and their effect on outcomes. Additionally, recent studies are evaluating the effect of the pandemic on PWE, barriers faced, and the usefulness of telehealth. Although there is still much to learn regarding COVID-19, current studies help in assessing the risk of seizures, guiding EEG utilization, and optimizing the use of telehealth during the pandemic.


Subject(s)
COVID-19 , Epilepsy , Status Epilepticus , COVID-19/epidemiology , Epilepsy/complications , Epilepsy/epidemiology , Epilepsy/therapy , Humans , Pandemics , Seizures/complications , Seizures/epidemiology , Seizures/therapy , Status Epilepticus/epidemiology , Status Epilepticus/etiology , Status Epilepticus/therapy
11.
Eur J Neurol ; 29(2): 626-647, 2022 02.
Article in English | MEDLINE | ID: covidwho-1518031

ABSTRACT

BACKGROUND AND PURPOSE: New-onset refractory status epilepticus (NORSE) is a clinical presentation, neither a specific diagnosis nor a clinical entity. It refers to a patient without active epilepsy or other pre-existing relevant neurological disorder, with a NORSE without a clear acute or active structural, toxic or metabolic cause. This study reviews the currently available evidence about the aetiology of patients presenting with NORSE and NORSE-related conditions. METHODS: A systematic search was carried out for clinical trials, observational studies, case series and case reports including patients who presented with NORSE, febrile-infection-related epilepsy syndrome or the infantile hemiconvulsion-hemiplegia and epilepsy syndrome. RESULTS: Four hundred and fifty records were initially identified, of which 197 were included in the review. The selected studies were retrospective case-control (n = 11), case series (n = 83) and case reports (n = 103) and overall described 1334 patients both of paediatric and adult age. Aetiology remains unexplained in about half of the cases, representing the so-called 'cryptogenic NORSE'. Amongst adult patients without cryptogenic NORSE, the most often identified cause is autoimmune encephalitis, either non-paraneoplastic or paraneoplastic. Infections are the prevalent aetiology of paediatric non-cryptogenic NORSE. Genetic and congenital disorders can have a causative role in NORSE, and toxic, vascular and degenerative conditions have also been described. CONCLUSIONS: Far from being a unitary condition, NORSE is a heterogeneous and clinically challenging presentation. The development and dissemination of protocols and guidelines to standardize diagnostic work-up and guide therapeutic approaches should be implemented. Global cooperation and multicentre research represent priorities to improve the understanding of NORSE.


Subject(s)
Drug Resistant Epilepsy , Encephalitis , Epileptic Syndromes , Status Epilepticus , Adult , Child , Drug Resistant Epilepsy/etiology , Drug Resistant Epilepsy/therapy , Encephalitis/complications , Epileptic Syndromes/complications , Epileptic Syndromes/diagnosis , Epileptic Syndromes/therapy , Humans , Retrospective Studies , Status Epilepticus/diagnosis , Status Epilepticus/etiology , Status Epilepticus/therapy
12.
Acta Biomed ; 92(5): e2021208, 2021 11 03.
Article in English | MEDLINE | ID: covidwho-1504536

ABSTRACT

Respiratory involvement is the most common clinical manifestation of COVID-19, but neurological symptoms and complications are increasingly being recognized. Seizures and status epilepticus (SE) have been described as possible consequences of hypoxia and metabolic derangements during SARS-CoV-2 infection, direct viral invasion of the central nervous system, or as para or post-infectious complications. Single episodes of SE have been described, occurring during the acute phase of COVID-19 or once the patients have been recovered. Herein, we present the case of a patient with a positive serology test for SARS-CoV-2 (IgG+, IgM-) and recurrent SE occurring within 36 days. Diagnostic work-up ruled out other known causes of SE. A post-COVID-19 infectious inflammatory/immune response is hypothesized as the possible trigger of SE.


Subject(s)
COVID-19 , Status Epilepticus , COVID-19 Testing , Humans , SARS-CoV-2 , Serologic Tests , Status Epilepticus/diagnosis , Status Epilepticus/etiology
14.
Neurol Sci ; 43(3): 2015-2020, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1358105

ABSTRACT

BACKGROUND: Neurological manifestations of COVID-19 infection are well recognized. Seizures and status epilepticus (SE) have been reported as possible manifestations and/or complications of SARS-CoV-2 infection at different disease stages, but few data are known about the type, severity, treatment response, and recurrence. METHODS: Single-center retrospective case series. RESULTS: This case series describes four COVID-19-positive patients admitted to an Italian University Hospital, who developed status epilepticus during the active phase of disease, independently from the severity of respiratory symptoms. Two of them presented a relapse after resolution of the acute viral infection, a feature that has not been previously reported. CONCLUSIONS: Although a possible association between SE and COVID-19 has been reported, the exact etiopathogenetic mechanism remains still not understood. Our series adds new insights to shed further light on this controversial issue.


Subject(s)
COVID-19 , Status Epilepticus , Humans , Retrospective Studies , SARS-CoV-2 , Seizures/diagnosis , Status Epilepticus/diagnosis , Status Epilepticus/etiology
16.
Epilepsy Behav ; 118: 107887, 2021 05.
Article in English | MEDLINE | ID: covidwho-1142315

ABSTRACT

PURPOSE: In March 2020, the World Health Organization declared the SARS-CoV-2 infection-related coronavirus Disease (COVID-19) a pandemic. During the first and second waves of the pandemic spread, there have been several reports of COVID-19-associated neurological manifestations, including acute seizures and status epilepticus (SE). In this systematic review, we summarized the available data on clinical features, diagnosis, and therapy of COVID-19-related SE. METHODS: We performed a systematic search of the literature to identify data on demographics, clinical, neurophysiological, and neuroradiological data of patients with COVID-19-related SE. We used regression models (linear or logistic) with a stepwise forward method to identify features associated with mortality or severity of SE. RESULTS: Thirty-nine articles were included with a total of 47 cases of SE associated with COVID-19. Age, time between the acute respiratory phase of SARS-CoV-2 infection and SE onset, and hospitalization correlated with a higher SE severity as assessed by quantitative validated scales. CONCLUSIONS: SE can be a neurological manifestation of SARS-CoV-2 infection. Although a possible association between SE and COVID-19 has been reported, the exact mechanisms are still not fully understood. Systemic inflammatory syndrome due to cytokine release could play a role in COVID-19-related SE.


Subject(s)
COVID-19 , Status Epilepticus , Humans , Pandemics , SARS-CoV-2 , Seizures , Status Epilepticus/diagnosis , Status Epilepticus/epidemiology , Status Epilepticus/etiology
17.
Neurol Sci ; 42(1): 35-38, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-910259

ABSTRACT

The 2019 new coronavirus (SARS-CoV-2) is a novel respiratory virus which has increasingly spread all over the world. Although the predominant clinical presentation is represented by respiratory symptoms, neurological manifestation of SARS-CoV-2 is being increasingly recognized. In the present report, we present a case of post SARS-CoV-2 autoimmune encephalitis associated with a new-onset refractory status epilepticus (NORSE).


Subject(s)
Autoimmune Diseases of the Nervous System/etiology , COVID-19/complications , Encephalitis/etiology , Status Epilepticus/etiology , Aged, 80 and over , Autoimmune Diseases of the Nervous System/diagnosis , Electroencephalography , Encephalitis/diagnosis , Humans , Male , Status Epilepticus/diagnosis
18.
BMJ Case Rep ; 13(10)2020 Oct 04.
Article in English | MEDLINE | ID: covidwho-814255

ABSTRACT

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Subject(s)
Antipsychotic Agents/adverse effects , Betacoronavirus , Clozapine/adverse effects , Coronavirus Infections/complications , Pneumonia, Viral/complications , Psychotic Disorders/drug therapy , Status Epilepticus/etiology , COVID-19 , Clozapine/therapeutic use , Diagnosis, Differential , Electroencephalography/methods , Female , Humans , Middle Aged , Pandemics , SARS-CoV-2 , Status Epilepticus/physiopathology
19.
Eur J Neurol ; 27(12): 2651-2657, 2020 12.
Article in English | MEDLINE | ID: covidwho-799153

ABSTRACT

AIM: The aim of this paper is to describe the clinical features of COVID-19-related encephalopathy and their metabolic correlates using brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) imaging. BACKGROUND AND PURPOSE: A variety of neurological manifestations have been reported in association with COVID-19. COVID-19-related encephalopathy has seldom been reported and studied. METHODS: We report four cases of COVID-19-related encephalopathy. The diagnosis was made in patients with confirmed COVID-19 who presented with new-onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) (FDG-PET/CT). RESULTS: The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID-19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG-PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy. CONCLUSIONS: Despite varied clinical presentations, all patients presented with a consistent FDG-PET pattern, which may reflect an immune mechanism.


Subject(s)
Brain Diseases/diagnostic imaging , COVID-19/complications , Aged , Brain Diseases/psychology , Brain Diseases/therapy , COVID-19/therapy , Cerebellar Diseases/diagnostic imaging , Cerebellar Diseases/etiology , Cognition Disorders/etiology , Cognition Disorders/psychology , Female , Fluorodeoxyglucose F18 , Frontal Lobe/diagnostic imaging , Humans , Immunotherapy , Magnetic Resonance Imaging , Male , Mental Disorders/etiology , Mental Disorders/psychology , Middle Aged , Myoclonus/diagnostic imaging , Myoclonus/etiology , Neuropsychological Tests , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Status Epilepticus/etiology , Treatment Outcome
20.
Clin Neurol Neurosurg ; 197: 106173, 2020 10.
Article in English | MEDLINE | ID: covidwho-764395

ABSTRACT

People with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, COVID-19, can have neurological problems including headache, anosmia, dysgeusia, altered mental status (AMS), ischemic stroke with or without large vessel occlusion, and Guillen-Barre Syndrome. Louisiana was one of the states hit hardest by the pandemic with just over 57,000 laboratory-confirmed cases of COVID-19 by the end of June 2020. We reviewed the electronic medical records (EMR) of patients hospitalized during the peak of the pandemic, March 1st through March 31st, to document the type and frequency of neurological problems seen in patients with COVID-19 at presentation to the emergency room. Secondary aims were to determine: 1) the frequency of neurological complaints during the hospital stay; 2) whether the presence of any neurological complaint at presentation or any of the individual types of neurological complaints at admission predicted three separate outcomes: death, length of hospital stay, or the need for intubation; and 3) if the presence of any neurological complaint or any of the individual types of neurological complaints developed during hospital stay predicted the previous three outcomes. A large proportion of our sample (80 %) was African American and had hypertension (79 %). Out of 250 patients, 56 (22 %) patients died, and 72 (29 %) patients required intubation. Thirty-four (14 %) had a neurological chief complaint at presentation; the most common neurological chief complaints in the entire sample were altered mental status (AMS) (8 %), headache (2 %), and syncope (2 %). We used a competing risk model to determine whether neurological symptoms at presentation or during hospital stay were predictors of prolonged hospital stay and death. To establish whether neurological symptoms were associated with higher odds of intubation, we used logistic regression. Age was the only significant demographic predictor of death and hospital stay. The HR (95 %CI) for remaining in the hospital for a ten-year increase in age was 1.2, (1.1, 1.3, p < 0.0001), and for death was 1.3, (1.1, 1.5, p < 0.01). There were no demographic characteristics, including age or comorbidities predictive of intubation. Adjusting for age, patients who at presentation had neurological issues as their chief complaint were at significantly increased risk for remaining in the hospital, HR = 1.7, (1.1,2.5, p = 0.0001), and dying, HR = 2.1(1.1,3.8, p = 0.02), compared to patients without any neurological complaint. Of the individual admission complaints, AMS was associated with a significantly prolonged hospital stay, HR = 1.8, (1.0-3.3, p = 0.05). Patients that required dialysis or intubation or had AMS during hospitalization had more extended hospital stays. After adjusting for age, dialysis, and intubation, patients with AMS during hospital stay had a HR of 1.6, (1.1, 2.5, p = 0.01) for remaining in the hospital. Patients who had statistically significant higher odds of requiring intubation were those who presented with any neurological chief complaint, OR = 2.8 (1.3,5.8, p = 0.01), or with headaches OR = 13.3 (2.1,257.0, p = 0.008). Patients with AMS during the hospital stay, as well as those who had seizures, were more likely to need intubation. In the multivariate model, dialysis, OR = 4.9 (2.6,9.4, p < 0.0001), and AMS, OR = 8.8 (3.9,21.2, p < 0.0001), were the only independent predictors of intubation. Neurological complaints at presentation and during the hospital stay are associated with a higher risk of death, prolonged hospital stay, and intubation. More work is needed to determine whether the cause of the neurological complaints was direct CNS involvement by the virus or the other systemic complications of the virus.


Subject(s)
Coronavirus Infections/physiopathology , Intubation, Intratracheal/statistics & numerical data , Length of Stay/statistics & numerical data , Nervous System Diseases/physiopathology , Pneumonia, Viral/physiopathology , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Emergency Service, Hospital , Female , Headache/etiology , Headache/physiopathology , Humans , Male , Middle Aged , Mortality , Nervous System Diseases/etiology , New Orleans , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prognosis , Proportional Hazards Models , Respiration, Artificial , SARS-CoV-2 , Seizures/etiology , Seizures/physiopathology , Status Epilepticus/etiology , Status Epilepticus/physiopathology , Stroke/etiology , Stroke/physiopathology , Syncope/etiology , Syncope/physiopathology
SELECTION OF CITATIONS
SEARCH DETAIL