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Alpha coma EEG pattern in patients with severe COVID-19 related encephalopathy.
Koutroumanidis, Michail; Gratwicke, James; Sharma, Simeran; Whelan, Aoife; Tan, S Veronica; Glover, Guy.
  • Koutroumanidis M; Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK. Electronic address: Michael.koutroumanidis@gstt.nhs.uk.
  • Gratwicke J; Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK.
  • Sharma S; Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK.
  • Whelan A; Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK.
  • Tan SV; Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK.
  • Glover G; Intensive Care Unit, St Thomas' Hospital, London, UK.
Clin Neurophysiol ; 132(1): 218-225, 2021 01.
Article in English | MEDLINE | ID: covidwho-807009
ABSTRACT

OBJECTIVE:

Encephalopathy is a major neurological complication of severe Coronavirus Disease 2019 (COVID-19), but has not been fully defined yet. Further, it remains unclear whether neurological manifestations are primarily due to neurotropism of the virus, or indirect effects, like cerebral hypoxia.

METHODS:

We analysed the electroencephalograms (EEGs) of 19 consecutive patients with laboratory-confirmed COVID-19, performed at peak disease severity as part of their clinical management. Disease severity, respiratory failure, immune and metabolic dysfunction, sedation status, and neurological examination on the day of the EEG were noted.

RESULTS:

Severe encephalopathy was confirmed in 13 patients, all with severe COVID-19; 10 remained comatose off sedation, and five of them had alpha coma (AC). Disease severity, sedation, immune and metabolic dysfunction were not different between those with AC and those without.

CONCLUSIONS:

Severe COVID-19 encephalopathy is a principal cause of persisting coma after sedation withdrawal. The relatively high incidence of the rare AC pattern may reflect direct SARS-CoV-2 neurotropism with a predilection for the brainstem ascending reticular system.

SIGNIFICANCE:

Systematic early EEG detection of encephalopathy related to severe COVID-19 is important for the acute care and the management of long-term neurological and cognitive sequelae, and may help our better understanding of its pathophysiology.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain / Brain Diseases / Coma / COVID-19 Type of study: Observational study / Prognostic study / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Clin Neurophysiol Journal subject: Neurology / Psychophysiology Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain / Brain Diseases / Coma / COVID-19 Type of study: Observational study / Prognostic study / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Clin Neurophysiol Journal subject: Neurology / Psychophysiology Year: 2021 Document Type: Article