Objective To systematically describe central (CNS) and peripheral (PNS) nervous system complications in hospitalized COVID-19 patients. Methods We conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission and discharge. Three-month follow-up data were collected using electronic health records. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related. Results From April to September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom required intensive care (ICU) management for respiratory failure. Forty-one CNS/PNS complications were identified in 28 of 61 (45.9%) patients and were more frequent in ICU compared to non-ICU patients. The most common CNS complication was encephalopathy ( n = 19, 31.1%), which was severe in 13 patients (GCS ≤ 12), including 8 with akinetic mutism. Length of ICU admission was independently associated with encephalopathy (OR = 1.22). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR = 1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were para/post-infectious, 34 were secondary to critical illness or other causes, and 4 remained unresolved. Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated. Conclusion CNS and PNS complications were common in hospitalized COVID-19 patients, particularly in the ICU, and often attributable to critical illness. When COVID-19 was the primary cause for neurological disease, no signs of viral neurotropism were detected, but laboratory changes suggested autoimmune-mediated mechanisms. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-020-10380-x.
【저자키워드】 COVID-19, SARS-CoV-2, Critical illness, coronavirus, Encephalopathy, Myelitis, 【초록키워드】 Critical illness, Respiratory failure, intensive care, stroke, Symptom, discharge, observational study, Encephalitis, ICU, Laboratory, Viral, Ischemic Stroke, management, Patient, ICU admission, nervous system, Complication, Neuropsychiatric, Encephalopathy, SARS-CoV-2 RNA, Myelitis, mechanisms, Follow-up, cerebrospinal fluid, Other, CNS, change, Admission, Intensive, Critical, COVID-19 patients, Immune-mediated, SARS-CoV-2 neurotropism, Electronic health records, neurological, biopsy, secondary to, transverse myelitis, meralgia paresthetica, akinetic mutism, during admission, Neurological disease, hospitalized COVID-19 patients, supplementary material, Adult patients, causes, non-ICU, non-ICU patients, meralgia, objective, independent, Result, enrolled, collected, caused, investigated, remained, required, conducted, screened, suggested, Length, 【제목키워드】 Cohort, nervous system, Complication, Follow-up,