Background: Previous reported neurologic sequelae associated with SARS-CoV-2 infection have mainly been confined to hospital-based patients in which viral detection was restricted to nasal/throat swabs or to IgM/IgG peripheral blood serology. Here we describe seven cases from Brazil of outpatients with previous mild or moderate COVID-19 who developed subacute cognitive disturbances. Methods: From June 1 to August 15, 2020, seven individuals 18 to 60 years old, with confirmed mild/moderate COVID-19 and findings consistent with encephalopathy who were observed >7 days after respiratory symptom initiation, were screened for cognitive dysfunction. Paired sera and CSF were tested for SARS-CoV-2 (IgA, IgG ELISA, and RT-PCR). Serum and intrathecal antibody dynamics were evaluated with oligoclonal bands and IgG index. Cognitive dysfunction was assessed by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Clock Drawing Test (CDT). Results: All but one of our patients were female, and the mean age was 42.6 years. Neurologic symptoms were first reported a median of 16 days (IQR 15–33) after initial COVID-19 symptoms. All patients had headache and altered behavior. Cognitive dysfunction was observed mainly in phonemic verbal fluency (MoCA) with a median of six words/min (IQR 5.25–10.75) and altered visuospatial construction with a median of four points (IQR 4–9) (CDT). CSF pleocytosis was not detected, and only one patient was positive for SARS-Co Conclusions: A subacute cognitive syndrome suggestive of SARS-CoV-2-initiated damage to cortico-subcortical associative pathways that could not be attributed solely to inflammation and hypoxia was present in seven individuals with mild/moderate COVID-19.
【저자키워드】 COVID-19, viral infection, Cognitive impairment, Executive function, Encephalopathies, 【초록키워드】 Brazil, SARS-CoV-2, IgG, Inflammation, hypoxia, serology, antibody, SARS-COV-2 infection, Test, Symptom, headache, RT-PCR, Moderate COVID-19, Peripheral blood, IgA, IgM/IgG, sera, female, Patient, pathway, Mild, Encephalopathy, age, Viral detection, Swab, IgG ELISA, assessment, COVID-19 symptoms, CSF, Outpatient, dysfunction, cognitive, examination, individual, syndrome, respiratory symptom, Montreal, positive, SARS-Co, neurologic, state, Seven, initial, tested, reported, evaluated, screened, median, the mean, associative, Drawing, IQR, verbal, 【제목키워드】 Subacute, individual, Sery,