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Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Our take —

This study provides a snapshot of the scope of neurological and neuropsychiatric complications associated with COVID-19 early in the pandemic in the UK. It contributes to a growing body of literature suggesting that COVID-19 may result in acute cerebrovascular events and altered mental status requiring hospitalization, with the former affecting primarily older patients and the latter disproportionately affecting younger patients. Future research to characterize the burden of morbidity due to COVID-19-associated neurological complications and evaluate the role of host and viral responses on the progression of longer-term neurological sequelae is warranted.

Study design

Case Series

Study population and setting

This study includes 153 possible (clinical suspicion in the absence of laboratory or imaging confirmation), probable (radiologic evidence in the absence of laboratory confirmation), and laboratory-confirmed (RT-PCR for viral RNA or serology positive for anti-SARS-CoV-2 IgM or IgG) COVID-19 cases reported by UK clinicians to the CoroNerve platform, an online network of nationwide rapid-response notification portals across all the major UK neuroscience and psychiatric organizations. The platform was launched on April 2, 2020, and data collection for this study includes the first three weeks of submission to the portal (through April 26, 2020). Cases were classified according to the following neuropsychiatric syndromes: a cerebrovascular event, altered mental status, peripheral neurology, or other. Additional data collection, including serial sample collection and longitudinal follow-up, was enabled through linkage with existing platforms.

Summary of Main Findings

Of the 153 cases (median age: 71 years) that presented between April 2 and April 26, 2020, data on sex were available for 117 (48% male). 125 cases (82%) had complete case details and were included in subsequent analyses, including 92% with confirmed SARS-CoV-2 infection, 4% probable cases, and 4% possible cases. Sixty-two percent of included patients (n=77) had a cerebrovascular event (74% had an ischemic stroke and 12% had an intracerebral hemorrhage), 31% (n=39) had altered mental status (16 with evidence of encephalitis; and 23 with a psychiatric diagnosis), 5% (n=6) had a peripheral disorder (4 with Guillain-Barre), and 2% (n=3) had other neurological disorders. Among the 23 patients with a psychiatric diagnosis, 10 had new-onset psychosis, 6 had a dementia-like syndrome, and 7 were classified as other. Only 2 of the psychiatric conditions were exacerbations of pre-existing mental illness. Of the cases who presented with altered mental status and had age data (n=37), 49% were less than 60 years old, while the patients who presented with cerebrovascular events and had age data (n=74) were predominantly older than 60 (82%).

Study Strengths

This study presented data from a large, nationwide rapid-response online surveillance system created to capture neurological complications of COVID-19 across the UK. The platform capitalized on the existence of an established network of UK neuroscience organizations working across both neurological and neuropsychiatric domains.

Limitations

This study was limited to the first 3 weeks after the surveillance platform was made available, when the phase of the epidemic was rising exponentially in the UK, and may not be generalizable to the distribution of syndromes during other phases of the pandemic. The study only included cases who were hospitalized for neurological and neuropsychiatric complications in the UK and therefore may not generalize to patients with less severe or more mild neurological symptoms who did not require hospitalization either in the UK or beyond. Given the data presented, it is also not possible to estimate the overall burden of neurological complications in patients with COVID-19. The lack of a comparison group or longitudinal follow-up precludes inferences about causality or risk factors.

Value added

This was the first nationwide surveillance effort in the UK to systematically capture COVID-19 cases presenting with neurological and neuropsychiatric complications requiring hospitalization.

This review was posted on: 15 September 2020