Objective Encephalopathy is a major neurological complication of severe Coronavirus Disease 2019 (COVID-19), but has not been fully defined yet. Further, it remains unclear whether neurological manifestations are primarily due to neurotropism of the virus, or indirect effects, like cerebral hypoxia. Methods We analysed the electroencephalograms (EEGs) of 19 consecutive patients with laboratory-confirmed COVID-19, performed at peak disease severity as part of their clinical management. Disease severity, respiratory failure, immune and metabolic dysfunction, sedation status, and neurological examination on the day of the EEG were noted. Results Severe encephalopathy was confirmed in 13 patients, all with severe COVID-19; 10 remained comatose off sedation, and five of them had alpha coma (AC). Disease severity, sedation, immune and metabolic dysfunction were not different between those with AC and those without. Conclusions Severe COVID-19 encephalopathy is a principal cause of persisting coma after sedation withdrawal. The relatively high incidence of the rare AC pattern may reflect direct SARS-CoV-2 neurotropism with a predilection for the brainstem ascending reticular system. Significance Systematic early EEG detection of encephalopathy related to severe COVID-19 is important for the acute care and the management of long-term neurological and cognitive sequelae, and may help our better understanding of its pathophysiology.

中文翻译：

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严重 COVID-19 相关脑病患者的阿尔法昏迷脑电图模式

目的 脑病是 2019 年严重冠状病毒病 (COVID-19) 的主要神经系统并发症，但尚未完全定义。此外，目前尚不清楚神经系统表现主要是由于病毒的神经性，还是间接影响，如脑缺氧。方法 我们分析了 19 名连续实验室确诊的 COVID-19 患者的脑电图 (EEG)，这些患者在疾病严重程度最高时进行了脑电图检查，作为临床管理的一部分。记录脑电图当天的疾病严重程度、呼吸衰竭、免疫和代谢功能障碍、镇静状态和神经系统检查。结果 13 名患者确诊为严重脑病，均为重症 COVID-19；10 人在停止镇静后仍处于昏迷状态，其中 5 人出现α昏迷 (AC)。患有 AC 的人和没有 AC 的人之间，疾病严重程度、镇静、免疫和代谢功能障碍没有差异。结论 严重的 COVID-19 脑病是镇静撤药后持续昏迷的主要原因。罕见 AC 模式的相对较高发生率可能反映了 SARS-CoV-2 的直接神经趋向性，偏爱脑干上升网状系统。意义 系统性早期脑电图检测与严重 COVID-19 相关的脑病对于急性护理以及长期神经和认知后遗症的治疗非常重要，并且可能有助于我们更好地了解其病理生理学。