Central and peripheral nervous system complications of COVID-19: A prospective tertiary center cohort with 3-month follow-up

  1. Vardan Nersesjan
  2. Moshgan Amiri
  3. Anne-Mette Lebech
  4. Casper Roed
  5. Helene Mens
  6. Lene Russel
  7. Lise Fonsmark
  8. Marianne Berntsen
  9. Sigurdur Thor Sigurdsson
  10. Jonathan Carlsen
  11. Annika Langkilde
  12. Pernille Martens
  13. Eva Løbner Lund
  14. Klaus Hansen
  15. Bo Jespersen
  16. Marie Norsker Folke
  17. Per Meden
  18. Anne-Mette Hejl
  19. Christian Wamberg
  20. Michael E. Benros
  21. Daniel Kondziella
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Abstract

Objective

To systematically describe CNS and PNS 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, at discharge and at 3-month follow-up. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related.

Results

From April-September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom were referred to ICU for respiratory failure. Evaluation revealed a higher frequency of CNS/PNS symptoms in ICU patients compared to non-ICU patients. The most common CNS complication was encephalopathy (n=22, 36.1%), which was severe in 13 patients (GCS≤12), including 8 with akinetic mutism. Length of ICU admission was an independent predictor of encephalopathy (OR=1.23). 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 classified as para/post-infectious. The remainder included cases secondary to critical illness or other causes (n=34) or without sufficient investigations (n=4). Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated.

Conclusions

CNS/PNS complications were common in hospitalized COVID-19 patients, particularly in ICU patients, and often attributable to critical illness. In cases with COVID-19 as the primary cause for neurological disease, there were no signs of viral neurotropism, but laboratory changes suggested autoimmune-mediated mechanisms.

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