Table 2.
Recommendations for reporting of clinical features, ancillary examination in patients with severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection and nervous system involvement
| General | Current symptoms, medical history, comorbidities and concomitant medication | |
|---|---|---|
| Clinical features and neurophysiological studies | Focal neurological signs | Findings of neurological examination |
| CNS | Acute/subacute, standardized definition of encephalopathy and encephalitis [16] | |
| PNS | Neurological examination, laboratory results with full myopathy panel and nerve conduction studies/electromyography | |
| Seizures | Report semiology and seizure type according to ILAE guidelines [28]; EEG findings according to standardized reporting | |
| Neuroimaging | Head CT | Report abnormal findings, brain edema, focal contrast enhancement, vascular status |
| Brain MRI | Abnormal findings, focal parenchymal, leptomeningeal contrast enhancement or vasculitic changes | |
| Spine MRI | Abnormal findings, contrast‐enhancement (including cranial nerves or peripheral nerve roots in cases of suspected acute neuropathy), myelopathy/atrophy | |
| SARS‐CoV‐2 viral RNA testing | Nasopharyngeal swab | Results; if multiple test performed, report time point of positive results |
| Immunoassay | Antibodies assay (IgM/IgG titers) | |
| CSF | Results PCR (qualitative and quantitative, if available) and IgM/IgG antibodies in CSF and serum (intrathecal SARS‐CoV‐2‐specific antibody production) | |
| CSF analysis | Routine analysis | Opening pressure, erythrocyte and leukocyte count with differential, glucose, proteins, oligoclonal bands and IgG index |
| Differential for neuroinfections and autoimmune conditions | Gram stain, bacterial culture, PCR testing for and common neurotropic viruses (HSV, VZV, enterovirus), cryptococcal antigen testing, venereal diseases testing (if suspected); further testing for the following infectious agents according to medical history, immune status, age and travel history: CMV, Toxoplasma gondii, Mycobacterium tuberculosis, Treponema pallidum, Borrelia species, opportunistic fungal infections, tick‐borne encephalitis virus, Toscana virus and West Nile virus | |
| Laboratory serum testing | Routine studies | Cell blood count and leukocyte differentials, D‐dimer, electroytes, LDH, C‐reactive protein, kidney and liver function |
| Infectious and autoimmune disease | Routine blood cultures, HIV serology, treponemal testing (if suspected), autoimmune antibodies | |
| Treatment | Antivirals, steroids/ immunomodulatory treatments, convulsive medication, symptomatic therapy | Specific drug type, dosage, route of administration |
| Outcome | Short (7 days) and long‐term outcome (3–6 months) |
CMV, cytomegalovirus; CNS, central nervous system; CSF, cerebrospinal fluid; CT, computerized tomography; EEG, electroencephalography; HIV, human immunodeficiency virus; HSV, Herpes simplex virus; Ig, immunoglobulin; ILAE, International League Against Epilepsy; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; PCR, polymerase chain reaction; PNS, peripheral nervous system; RNA, ribonucleic acid; VZV, Varicella‐zoster virus.