Objective

To describe the clinical, neurological, neuroimaging, and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center.

Methods

We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020.

Results

Fifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate, and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series, the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2), or severe (3), p < 0.001).

Conclusion

In our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.

中文翻译：

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COVID-19 脑病的临床、脑脊液和神经影像学发现：病例系列

 客观的

描述与 COVID-19 三级参考中心收治的患者脑病相关的临床、神经学、神经影像学和脑脊液 (CSF) 结果。

 方法

我们回顾性审查了2020年3月30日至2020年5月15日期间由神经病学咨询团队评估的连续COVID-19患者的记录。

 结果

纳入 55 名确诊 SARS-CoV-2 患者，其中 43 名出现脑病，并进一步分为轻度、中度和重度脑病组。 19 名患者 (44%) 接受了机械通气并接受静脉注射镇静剂。 11 名 (26%) 患者正在接受透析。 COVID-19 严重程度的实验室标志物在脑病患者中非常常见，但与脑病的严重程度无关。三十九名患者接受了神经影像学研究，结果显示大部分是非特异性变化。一名患者表现出可能与中枢神经系统脱髓鞘有关的病变。其中四人患有急性中风。 RT-PCR 仅在 21 份脑脊液样本中检测到 SARS-CoV-2。两份脑脊液样本显示白细胞计数升高，且寡克隆条带均为阴性。在我们的病例系列中，脑病的严重程度与住院期间较高的死亡概率相关（脑病程度每次增加，OR = 5.5，从无（0）到轻度（1）、中度（2）或重度（3） ）， p < 0.001）。

 结论

在我们对 43 例脑病病例进行的连续系列研究中，神经影像学和脑脊液分析并不支持病毒直接侵袭中枢神经系统或中枢神经系统炎症是脑病的病因。