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COVID-19 encephalopathy: Clinical and neurobiological features.
Uginet, Marjolaine; Breville, Gautier; Assal, Frédéric; Lövblad, Karl-Olof; Vargas, Maria Isabel; Pugin, Jérôme; Serratrice, Jacques; Herrmann, Francois R; Lalive, Patrice H; Allali, Gilles.
  • Uginet M; Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Breville G; Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Assal F; Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Lövblad KO; Division of Neuroradiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
  • Vargas MI; Division of Neuroradiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
  • Pugin J; Division of Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Serratrice J; Division of General Internal Medicine, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Herrmann FR; Department of Rehabilitation and Geriatrics, Division of Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Lalive PH; Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Allali G; Diagnostic Department, Division of Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.
J Med Virol ; 93(7): 4374-4381, 2021 07.
Article in English | MEDLINE | ID: covidwho-1156881
ABSTRACT
Severe acute respiratory coronavirus 2 (SARS-CoV-2) has been associated with neurological complications, including acute encephalopathy. To better understand the neuropathogenesis of this acute encephalopathy, we describe a series of patients with coronavirus disease 2019 (COVID-19) encephalopathy, highlighting its phenomenology and its neurobiological features. On May 10, 2020, 707 patients infected by SARS-CoV-2 were hospitalized at the Geneva University Hospitals; 31 (4.4%) consecutive patients with an acute encephalopathy (64.6 ± 12.1 years; 6.5% female) were included in this series, after exclusion of comorbid neurological conditions, such as stroke or meningitis. The severity of the COVID-19 encephalopathy was divided into severe and mild based on the Richmond Agitation Sedation Scale (RASS) severe cases (n = 14, 45.2%) were defined on a RASS < -3 at worst presentation. The severe form of this so-called COVID-19 encephalopathy presented more often a headache. The severity of the pneumonia was not associated with the severity of the COVID-19 encephalopathy 28 of 31 (90%) patients did develop an acute respiratory distress syndrome, without any difference between groups (p = .665). Magnetic resonance imaging abnormalities were found in 92.0% (23 of 25 patients) with an intracranial vessel gadolinium enhancement in 85.0% (17 of 20 patients), while an increased cerebrospinal fluid/serum quotient of albumin suggestive of blood-brain barrier disruption was reported in 85.7% (6 of 7 patients). Reverse transcription-polymerase chain reaction for SARS-CoV-2 was negative for all patients in the cerebrospinal fluid. Although different pathophysiological mechanisms may contribute to this acute encephalopathy, our findings suggest the hypothesis of disturbed brain homeostasis and vascular dysfunction consistent with a SARS-CoV-2-induced endotheliitis.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain / Brain Diseases / COVID-19 Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: J Med Virol Year: 2021 Document Type: Article Affiliation country: Jmv.26973

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain / Brain Diseases / COVID-19 Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: J Med Virol Year: 2021 Document Type: Article Affiliation country: Jmv.26973