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Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study

Stéphane Kremer 1 François Lersy 1 Mathieu Anheim 2 Hamid Merdji 1 Maleka Schenck 3 Hélène Oesterlé 1 Federico Bolognini 1 Julien Messie 1 Antoine Khalil 4, 5 Augustin Gaudemer 4 Sophie Carré 5 Manel Alleg 6 Claire Lecocq 5 Emmanuelle Schmitt 6 René Anxionnat 6 François Zhu 6 Lavinia Jager 7 Patrick Nesser 7 Yannick Talla Mba 7 Ghazi Hmeydia 8 Joseph Benzakoun 8 Catherine Oppenheim 8 Jean-Christophe Ferré 9, 10 Adel Maamar 11 Béatrice Carsin-Nicol 10 Pierre-Olivier Comby 11 Frédéric Ricolfi 11 Pierre Thouant 11 Claire Boutet 12 Xavier Fabre 13 Géraud Forestier 14 Isaure de Beaurepaire 15 Grégoire Bornet 15 Hubert Desal 16 Grégoire Boulouis 8 Jérome Berge 17 Apolline Kazémi 18 Nadya Pyatigorskaya 19, 20 Augustin Lecler 21 Suzana Saleme 14 Myriam Edjlali-Goujon 8 Basile Kerleroux 8 Jean-Marc Constans 22 Pierre-Emmanuel Zorn 1 Muriel Mathieu 1 Seyyid Baloglu 1 François-Daniel Ardellier 1 Thibault Willaume 1 Jean-Christophe Brisset 23 Sophie Caillard 1, 24 Olivier Collange 1 Paul Michel Mertes 1 Francis Schneider 3 Samira Fafi-Kremer 1, 24 Mickael Ohana 25 Ferhat Meziani 1 Nicolas Meyer 25 Julie Helms 1, 24 François Cotton 26
Abstract : Objective To describe neuroimaging findings and to report the epidemiologic and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with neurologic manifestations. Methods In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI. Results The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20–92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome ( p = 0.006) and more frequently had corticospinal tract signs ( p = 0.02). Patients with encephalitis were younger ( p = 0.007), whereas agitation was more frequent for patients with leptomeningeal enhancement ( p = 0.009). Conclusions Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF. ClinicalTrials.gov identifier NCT04368390.
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https://www.hal.inserm.fr/inserm-03482260
Contributor : Jean-Christophe Ferré Connect in order to contact the contributor
Submitted on : Wednesday, December 15, 2021 - 5:53:58 PM
Last modification on : Tuesday, January 4, 2022 - 6:14:43 AM

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Stéphane Kremer, François Lersy, Mathieu Anheim, Hamid Merdji, Maleka Schenck, et al.. Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study. Neurology, American Academy of Neurology, 2020, 95 (13), pp.e1868-e1882. ⟨10.1212/WNL.0000000000010112⟩. ⟨inserm-03482260⟩

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