Elsevier

World Neurosurgery

Volume 141, September 2020, Pages e437-e446
World Neurosurgery

Original Article
Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience

https://doi.org/10.1016/j.wneu.2020.05.192Get rights and content

Background

The coronavirus 2019 (COVID-19) pandemic has had a dramatic impact on health care systems and a variable disease course. Emerging evidence demonstrates that severe acute respiratory syndrome coronavirus 2 is associated with central nervous system disease. We describe central nervous system manifestations in critical patients with COVID-19 at our tertiary center.

Methods

We conducted a single-center retrospective analysis of all actively critical patients with COVID-19 admitted to our tertiary care academic center in New Orleans, Louisiana, on April 22, 2020, with new onset of neurologic disease. Patients were grouped into 1 of 3 categories according to imaging and clinical features; encephalopathy, acute necrotizing encephalopathy, and vasculopathy.

Results

A total of 27 of 76 (35.5%) critical patients with COVID-19 met inclusion criteria. Twenty patients (74%) were designated with COVID-19–associated encephalopathy, 2 (7%) with COVID-19–associated acute necrotizing encephalopathy, and 5 (19%) with COVID-19–associated vasculopathy. Sixty-three percent of neurologic findings were demonstrated on computed tomography, 30% on magnetic resonance imaging, and 44% on electroencephalography. Findings most often included ischemic strokes, diffuse hypoattenuation, subcortical parenchymal hemorrhages, and focal hypodensities within deep structures. Magnetic resonance imaging findings included diffuse involvement of deep white matter, the corpus callosum, and the basal ganglia. For patients with large-territory ischemic stroke, all but one displayed irregular proximal focal stenosis of the supraclinoid internal carotid artery.

Conclusions

Analysis of active critical COVID-19 admissions at our revealed a high percentage of patients with new neurologic disease. Although variable, presentations followed 1 of 3 broad categories. A better understanding of the neurologic sequalae and radiographic findings will help clinicians mitigate the impact of this disease.

Key words

Cerebrovascular disease
Infectious disease
Neurologic surgery
SAR-CoV-2

Abbreviations and Acronyms

ADEM
Acute disseminated encephalomyelitis
ARDS
Acute respiratory distress syndrome
CNS
Central nervous system
COVID-19
Coronavirus disease 2019
CRRT
Continuous renal-replacement therapy
CSF
Cerebrospinal Fluid
CT
Computed tomography
CTA
Computed tomography angiography
DM2
Diabetes mellitus type 2
EEG
Electroencephalography
FLAIR
Fluid-attenuated inversion recovery
IAE
Influenza-associated encephalopathy
ICA
Internal carotid artery
ICH
Intracerebral hemorrhage
ICU
Intensive care unit
LVO
Large-vessel occlusion
MCA
Middle cerebral artery
MERS
Middle Eastern respiratory syndrome
MRA
Magnetic resonance angiography
MRI
Magnetic resonance imaging
NAAT
Nucleic acid amplification technique
PLEX
Plasma exchange
RICU
Respiratory intensive care Unit
RT-PCR
Reverse transcriptase polymerase chain reaction
SARS-CoV-1
Severe Acute Respiratory Distress Syndrome Coronavirus 1
SARS-CoV-2
Severe acute respiratory distress syndrome coronavirus 2
SWI
Susceptibility-weighted imaging
VZV
Varicella zoster virus

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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