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Neurological manifestations associated with COVID-19: a nationwide registry
Elodie Meppiel; Nathan Peiffer-Smadja; Alexandra Maury; Imen Bekri; Cecile Delorme; Virginie Desestret; Lucas Gorza; Geoffroy Hautecloque-Raysz; Sophie Landre; Annie Lannuzel; Solene Moulin; Peggy Perrin; Paul Petitgas; Francois Sellal; Adrien Wang; Pierre Tattevin; Thomas de Broucker; - contributors to the NeuroCOVID registry.
  • Elodie Meppiel; Department of Neurology, Centre Hospitalier de Saint-Denis, Hopital Delafontaine, F-93200 Saint-Denis, France
  • Nathan Peiffer-Smadja; Inserm
  • Alexandra Maury; Department of Neurology, Centre Hospitalier de Saint-Denis, Hopital Delafontaine, F-93200 Saint-Denis, France
  • Imen Bekri; Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, F-78150 Le Chesnay, France
  • Cecile Delorme; Department of Neurology, Pitie-Salpetriere Hospital, Assistance-Publique Hopitaux de Paris, F-75013 Paris, France
  • Virginie Desestret; Department of Neuro-cognition and Neuro-ophthalmology, Hospices Civils de Lyon
  • Lucas Gorza; Department of Neurology, Hopital Foch
  • Geoffroy Hautecloque-Raysz; Department of Neurology, Hopitaux civils de Colmar
  • Sophie Landre; Department of Infectious Diseases, Hospices Civils de Lyon
  • Annie Lannuzel; Department of Neurology, Centre Hospitalier Universitaire de la Guadeloupe
  • Solene Moulin; Department of Neurology, Centre Hospitalier Universitaire, Hopital Maison Blanche
  • Peggy Perrin; Department of Nephrology, Hopitaux Universitaires de Strasbourg
  • Paul Petitgas; Department of Infectious Diseases and Intensive Care Medicine, Centre Hospitalier Universitaire de Rennes
  • Francois Sellal; Department of Neurology, Hopitaux civils de Colmar
  • Adrien Wang; Department of Neurology, Hopital Foch
  • Pierre Tattevin; Department of Infectious Diseases and Intensive Care Medicine, Centre Hospitalier Universitaire de Rennes
  • Thomas de Broucker; Department of Neurology, Centre Hospitalier de Saint-Denis, Hopital Delafontaine, F-93200 Saint-Denis, France
  • - contributors to the NeuroCOVID registry;
Preprint Dans Anglais | medRxiv | ID: ppmedrxiv-20154260
ABSTRACT
BackgroundThe clinical description of the neurological manifestations in COVID-19 patients is still underway. This study aims to provide an overview of the spectrum, characteristics and outcomes of neurological manifestations associated with SARS-CoV-2 infection. MethodsWe conducted a nationwide, multicentric, retrospective study during the French COVID-19 epidemic in March-April 2020. All COVID-19 patients with de novo neurological manifestations were eligible. ResultsWe included 222 COVID-19 patients with neurological manifestations from 46 centers throughout the country. Median age was 65 years (IQR 53-72), and 136 patients (61.3%) were male. COVID-19 was severe or critical in almost half of the patients (102, 45.2%). The most common neurological diseases were COVID-19 associated encephalopathy (67/222, 30.2%), acute ischemic cerebrovascular syndrome (57/222, 25.7%), encephalitis (21/222, 9.5%), and Guillain-Barre Syndrome (15/222, 6.8%). Neurological manifestations appeared after first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19 associated encephalopathy, 7 (5-10) days in encephalitis, 12 (7-18) days in acute ischemic cerebrovascular syndrome and 18 (15-28) days in Guillain-Barre Syndrome. Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Brain MRI of encephalitis patients showed heterogeneous acute non vascular lesion in 14/21 patients (66.7%) with associated small ischemic lesion or microhemorrhages in 4 patients. Among patients with acute ischemic cerebrovascular syndrome, 13/57 (22.8%) had multi territory ischemic strokes, with large vessel thrombosis in 16/57 (28.1%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with pleocytosis in 18 patients (18.6%). A SARS-CoV-2 PCR was performed in 75 patients and was positive only in 2 encephalitis patients. Among patients with encephalitis, ten out of 21 (47.6%) fully recovered, 3 of whom received corticosteroids (CS). Less common neurological manifestations included isolated seizure (8/222, 3.6%), critical illness neuropathy (8/222, 3.6%), transient alteration of consciousness (5/222, 2.3%), intracranial hemorrhage (5/222, 2.3%), acute benign lymphocytic meningitis (3/222, 1.4%), cranial neuropathy (3/222, 1.4%), single acute demyelinating lesion (2/222, 0.9%), Tapia syndrome (2/222, 0.9%), cerebral venous thrombosis (1/222, 0.5%), sudden paraparesis (1/222, 0.5%), generalized myoclonus and cerebellar ataxia (1/222, 0.5%), bilateral fibular palsy (1/222, 0.5%) and isolated neurological symptoms (headache, anosmia, dizziness, sensitive or auditive symptoms, hiccups, 15/222, 6.8%). The median (IQR) follow-up of the 222 patients was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%). ConclusionNeurological manifestations associated with COVID-19 mainly included CAE, AICS, encephalitis and GBS. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.
Texte intégral: Disponible Collection: Preprints Base de données: medRxiv Type d'étude: Étude de cohorte / Étude observationnelle / Étude pronostique langue: Anglais Année: 2020 Type de document: Preprint

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Texte intégral: Disponible Collection: Preprints Base de données: medRxiv Type d'étude: Étude de cohorte / Étude observationnelle / Étude pronostique langue: Anglais Année: 2020 Type de document: Preprint