COVID-19 international neurological registries

The pandemic of coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already affected more than 2·7 million people and caused more than 192 000 deaths worldwide. Respiratory symptoms are the most common, and neurogenic breathing failure is suspected to be involved.¹ Symptoms such as anosmia, dysgeusia, headache, and muscle pain have been noted, along with reports of central and peripheral nervous system involvement. Mao and colleagues² reported on 214 patients who were admitted to hospital in Wuhan, China, with acute COVID-19. Symptoms were severe in 59% (mean age 58·7 years) of these patients, and non-severe in 41% (mean age 49·9 years). In total, 78 (36%) of 214 patients had neurological compromise, which was more common in severe (46%) than in non-severe (30%) cases and included stroke, impaired consciousness, myopathy, and neuralgic pain. Viral meningoencephalitis with presence of SARS-CoV-2 in CSF by viral genome sequencing has been reported in patients in China³ and Japan.⁴ In the USA, a woman aged between 50 and 60 years developed COVID-19 and altered mental status. Brain MRI on this patient showed bilateral haemorrhagic rim-enhancing lesions within thalami, medial temporal lobes, and subinsular regions characteristic of acute haemorrhagic necrotising encephalopathy.⁵ This condition also, but rarely, occurs in influenza and other encephalitides in association with cytokine storm syndrome.

Amid confronting a severe outbreak of COVID-19, the Spanish Neurological Society (Sociedad Española de Neurología) implemented a registry of neurological manifestations in patients with confirmed COVID-19. We applaud this initiative and propose to expand these efforts globally to define the nervous system involvement in COVID-19. The Environmental Neurology Specialty Group of the World Federation of Neurology (ENSG-WFN) is encouraging neurological societies around the world to develop national or regional neuroepidemiological databanks to report all cases of new-onset, acute, delayed, and any long-latency neurological disorders associated with SARS-CoV-2 infection during the COVID-19 pandemic. Late parkinsonism occurred among survivors of the 1918–20 influenza pandemic. Therefore, neurologists must be prepared for the occurrence of delayed neurological manifestations of COVID-19.

The worldwide response to the pandemic indicates that neurologists and other physicians, government authorities, and scientists with expertise in public health, epidemiology, infectious diseases, virology, and other relevant fields will be willing to advise and assist their local neurological societies to create databases of neurological manifestations related to COVID-19. These databases will also encourage much needed peer-reviewed publications of the neurological implications of the pandemic. The ENSG-WFN will work to assure that the results of the national and regional registries are collected, posted, and become freely available on the WFN website. This global effort should help develop an understanding of the neurological impact of COVID-19.