Table 3.
Neurologic assessment in COVID-19 patients with acute ischaemic cerebrovascular syndrome, encephalitis, encephalopathy and GBS
| Characteristic | Acute ischaemic cerebrovascular syndrome (n = 57) | Encephalitis (n = 21) | Encephalopathy (n = 67) | GBS (n = 15) |
|---|---|---|---|---|
| Brain imaging | 57 (100) | 21 (100) | 57 (85.1) | 5 (33.3) |
| CT scan | 9 (15.8) | 0 | 12 (17.9) | 0 |
| MRI | 48 (84.2) | 21 (100) | 45 (67.2) | 5 (33.3) |
| Acute ischaemic lesion | 52 (91.7) | 2 (9.5) | 6 (9) | 2 (13.3) |
| Unifocal ischaemic lesion | 39 (68.4) | 1 (4.8) | 1 (1.5) | 1 (6.7) |
| Multifocal ischaemic lesions | 13 (22.8) | 1 (4.8) | 5 (7.5) | 1 (6.7) |
| Large vessel infarct | 46 (88.4)a | 0 | 0 | 1 (6.7) |
| Small vessel infarct | 6 (11.5) | 2 (9.5) | 6 (9) | 1 (6.7) |
| Microhemorrhages | 0 | 2 (9.5) | 2 (3) | 0 |
| Other lesion | 0 | 14 (66.7)b | 1 (1.5)c | 0 |
| Spine MRI | 0 | 0 | 2 (3) | 3 (20) |
| Any lesion | — | — | 0 | 0 |
| Cerebrospinal fluid examination | 3 (5.2) | 21 (100) | 36 (53.7) | 14 (93.3) |
| Normal | 3 (5.2) | 3 (14.3) | 28 (41.8) | 5 (33.3) |
| WBC count >5/mm³ | — | 14 (66.7) | 0 | 1 (6.7) |
| Proteins >0.45 g/L | — | 12 (57.1) | 8 (11.9) | 8 (53.3) |
| Isolated elevated proteins | — | 4 (19.0) | 8 (11.9) | 8 (53.3) |
| Positive SARS-CoV-2 PCR | 0 | 2 (9.5) | 0 | 0 |
| Electroencephalogram | 4 (7.0) | 15 (71.4) | 32 (47.8) | 2 (14.3) |
| Normal | 0 | 1 (4.8) | 6 (9) | 0 |
| Diffuse slowing | 3 (5.3) | 9 (42.9) | 17 (25.4) | 1 (6.7) |
| Anterior slowing | 0 | 2 (9.5) | 5 (7.5) | 1 (6.7) |
| Focal lateralized slowing and/or paroxysm | 1 (1.8) | 4 (19) | 8 (11.9) | 0 |
| Periodic pattern | 0 | 1 (4.8) | 3 (4.5) | 0 |
| Status epilepticus | 0 | 1 (4.8) | 1 (1.5) | 0 |
| Electroneuromyography | 1 (1.8) | 1 (4.8) | 3 (4.5) | 14 (93.3) |
| Abnormal findings | 1 (1.8) | 1 (4.8) | 3 (4.5) | 13 (86.7) |
| Axonal injury | 1 (1.8) | 1 (4.8) | 1 (1.5) | 0 |
| Demyelination | 1 (1.8) | 0 | 2 (3) | 13 (86.7) |
Data are presented as n (%). COVID-19, coronavirus disease 2019; CT, computed tomography; FLAIR, fluid-attenuated inversion recovery; GBS, Guillain-Barré syndrome; MRI, magnetic resonance imaging; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; WBC, white blood cell count.
Among 46 patients with large vessel infarct, 16 had a persisting thrombosis located in internal carotid artery (n = 9) and/or proximal segment of middle cerebral artery (n = 6) or in basilar artery (n = 1).
Basal ganglia FLAIR hyperintensity (n = 3), acute diffuse hemispheric white matter lesions (n = 2), FLAIR hyperintensity of genu of corpus callosum (n = 1), mesiotemporal FLAIR hyperintensity (n = 3) with frontoinsular extension in 2, brainstem and cerebellar peduncular FLAIR hyperintensity (n = 2), cranial nerve FLAIR hyperintensity (n = 1), focal leptomeningeal FLAIR hyperintensity (n = 2).
Lesion in splenium of corpus callosum typical of mild encephalopathy with reversible splenial lesion syndrome.